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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215085
Report Date: 07/12/2019
Date Signed: 07/12/2019 04:03:32 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GUZMAN FCC AKA ERIKA'S DAY CAREFACILITY NUMBER:
426215085
ADMINISTRATOR:ERIKA GUZMAN/LEGALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(815) 213-2869
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 11DATE:
07/12/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Erika GuzmanTIME COMPLETED:
04:10 PM
NARRATIVE
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A comprehensive annual random review was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and E. Baddley who met with Licensee Erika Guzman, her husband Pedro Guzman, and her adult son who providing care to eleven children. The home was toured inside and outside. The home was observed to be clean and orderly. Licensee stated there are no firearms/ammunition or bodies of water on the premises.
There smoke detector and carbon monoxide detector were tested and found to be operational. There is a 2 A10 BC Fire Extinguisher tag is dated 08/07/2018. Licensee was reminded to service the fire extinguisher yearly. The last fire drill documented is 06/04/2019. LPA reviewed children's records, including the child care roster. LPA reviewed the handout "A Child Care Provider's Guide to Safe Sleep, Safe Sleep in Child Care, and Effects of Lead Exposure". LPA reviewed current CPR and First Aid for Licensee Erika Guzman, Pedro Guzman and Martin Guzman (expires 03/16/2021). LPA reviewed the requirement for care providers/employees and volunteers to obtain immunization against Influenza, Pertussis, and Measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or decline. LPA reviewed verification of immunization for Licensee, her husband and her adult son. LPA reviewed completion of the AB 1207 Child Abuse Mandated Reporter Training for Erika Guzman and Pedro Guzman.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUZMAN FCC AKA ERIKA'S DAY CARE
FACILITY NUMBER: 426215085
VISIT DATE: 07/12/2019
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No deficiencies cited.

LPA observed the "Notice of Site Visit" posted.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
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