426215321-1-3-2020-17-CC-EBAY-BKGS75-20200103123658

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215321
Report Date: 01/03/2020
Date Signed: 01/03/2020 12:37:11 PM

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:	RODRIGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	426215321
ADMINISTRATOR:	ELIZABETH RODRIGUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 201-8992
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	14	CENSUS: 3	DATE:	01/03/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Elizabeth Rodriguez		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On January 3, 2019, at 10;45 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Elizabeth Rodriguez, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. The FCCH's assistant, Jessica Barajas acted as a translator for the Licensee who is primarily Spanish Speaking. The home’s living room, backyard, and hallway restroom are used for child care, while the home’s bedrooms and laundry room are excluded from child care. At the time of the inspection three children are present. The FCCH was void of hazardous items. Medication at the FCCH is stored in the bedrooms which are inaccessible to children. Cleaning compounds are stored under the kitchen sink which is also inaccessible to children. Toys, furniture and equipment observed in the FCCH are age appropriate. Required forms are posted on the wall of the FCCH's living room. The FCCH has a fireplace which is screened and inaccessible to children. LPA observed a combination smoke and carbon monoxide detector which were tested and found to be operable. The FCCH has a regulation fire extinguisher which was purchased January 8, 2019. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The backyard is enclosed by wooden fencing and has a sandbox play area as well as a covered play structure. Toys and play equipment observed in the backyard are age appropriate and in satisfactory condition. No bodies of water were observed on site. A sampling of the children records were reviewed. At 11:30 AM, LPA reviewed the records of Child #1 and the Consent for Emergency Medical Treatment form (LIC 627) was absence. LPA discussed the regulatory mandate to have the aforementioned in each child's file. The Licensee's records are current and complete with Pediatric CPR and First Aid certifications expiring on May 16, 2020. CONT. 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 426215321
	VISIT DATE: 01/03/2020

NARRATIVE

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Licensee informed LPA no firearms or ammunition are stored on site.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. When any IMS is provided, a Plan for Providing 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: www.ada.gov/childqanda.htm

LPA reviewed and provided Licensee with a copy of “Child Care Providers Guide to Safe Sleep." LPA reviewed and provided “Effects of Lead Exposure” to be distributed to all families. Licensee was reminded of the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

Today, deficiency cited under Title 22 Division 12 Appeal rights given.
Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D). The Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The LIC 9213 (Notice of Site visit) was posted during today's visit.

The LIC 9213 (Notice of Site visit) was posted during today's visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 426215321
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/10/2020 Section Cited	1 2 3 4 5 6 7	CCR 102417 Operation of a Family Child Care Home An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency...and the parent's authorization for the licensee or
	8 9 10 11 12 13 14	registrant to consent to emergency medical care. This requirement was not met as evidenced by the following: Based on the LPA's observation/record review Licensee did not have Consent for Emergency Medical Treatment form in Child #1 file. This poses a potential risk to the health, safety or personal rights of persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

LIC809 (FAS) - (06/04)

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