426215321-1-3-2022-17-CC-GRES-CAC3AU-20220103170518

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215321
Report Date: 01/03/2022
Date Signed: 01/03/2022 05:05:24 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: 5	DATE:	01/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Elizabeth Rodriguez		TIME COMPLETED:	05:00 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 1/3/2021 @ 2:00 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced 1 Year Required Inspection. LPA asked Covid-19 screening questions prior to the inspection and spoke with Licensee. When LPA arrived, LPA met with assistant Jessica Barajas and discussed the purpose of the inspection. Assistant stated, Licensee left before LPA arrived at FCCH for a personal appointment. LPA toured of the facility inside and out. There were five (5) children a present during the inspection. During the tour, LPA observed the following, required forms are posted in the wall by the entrance door, appropriate fire extinguisher was purchased on 3/18/2021. Day care utilizes the living room and dining areas. Bedroom and kitchen are not accessible to day care children. At 2:10 PM, smoke and carbon monoxide detectors were tested and found functional. Cleaning compounds are stored under the kitchen sink which is inaccessible to children. LPA observed age appropriate toys, furniture and equipment in the FCCH. The backyard is completely fenced with age appropriate toys and equipment. Nobodies of water was observed. Assistant stated there are no guns or ammunition in the home. LPA reviewed the following documents, Assistant's Pediatric CPR and First Aid Card expires on 5/31/2023. Assistant stated her Mandated Reporter Training Certificate expired on 4/5/2018. Licensee's and assistant's immunization records are complete per SB 792 Fire and Disaster drill is conducted and logged every 6 months. Last drill was conducted on 11/6/2021. Children’s roster is current. LPA reviewed children records. The records were current, complete and possessed emergency contact information as mandated by regulations.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

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: 01/03/2022

NARRATIVE

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FCCH is not providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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: http://www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

LPA discussed current Safe Sleep and Covid-19 requirements with Assistant. Assistant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

During today's inspection deficiency was cited under California Code of Regulation Title 22 Division 12. Deficiencies are documented under LIC 809 D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Assistant.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

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: 01/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee and assistant did not comply with the section cited above, assistant stated her Mandated Reporter Training Certificate expired on 4/5/2020 and she has not completed the renewal of the said training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/17/2022
	Plan of Correction
1 2 3 4	Licensee and assistant agreed to renew Mandated Reporter Training and submit the certificate to CCLD on or before 1/17/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

LIC809 (FAS) - (06/04)

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