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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215464
Report Date: 06/10/2022
Date Signed: 06/10/2022 04:47:46 PM


Document Has Been Signed on 06/10/2022 04:47 PM - It Cannot Be Edited

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:KAHAE FCC AKA ALOHA KEIKI DAY CAREFACILITY NUMBER:
426215464
ADMINISTRATOR:THERESA ANNE KAHAEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 720-0505
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 3DATE:
06/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:THERESA ANNE KAHAETIME COMPLETED:
04:55 PM
NARRATIVE
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On 6/10/22, at 1:35 PM Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Required inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Theresa Anne Kahae, Licensee of the FCCH and explained the nature and purpose of the inspection. LPA notes three (3) children are on site during this inspection.

LPA, in the company of the Licensee, toured the exterior and interior of the FCCH. The home’s living room, dining area, bathroom and outdoor yard are used for child care services, while the bedrooms, second floor, kitchen and garage are excluded from services. At 2:02, LPA observed that there is no gate making the stairs inaccessible to children in care. Licensee stated that she is having a hard time finding something to block off the stairway because of the way it is positioned. Licensee also stated that a plant is placed in front of the stairway to create a barrier. Today, the plant was not in front of the stairway and located directly next to the stairs.

The FCCH is orderly and has ventilation to afford for the children’s comfort and safety. Medication in the FCCH is stored in a cabinet in the hallway of the home. Cleaning compounds were observed to be stored in a cabinet in the hallway of the home, under the sink of the bathroom, under the sink of the kitchen and in the garage. LPA notes that all cabinets are inaccessible to children in care by means of magnetic locks. Sharps in the facility are stored in the counter of the kitchen. LPA notes that there is a gate making the kitchen inaccessible to children in care. Toys, furniture and equipment observed in the FCCH are age appropriate.

Required forms are posted on the FCCH living room wall. The FCCH has smoke and carbon monoxide detectors which were tested at 2:15 pm and found to be operable. The FCCH has a regulation fire extinguisher that has expired. During this inspection, Licensee attempted to make an appointment so that the fire extinguisher can be serviced, but no one answered. LPA heard Licensee leave a detailed voicemail message requesting this service. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2022
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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Document Has Been Signed on 06/10/2022 04:47 PM - It Cannot Be Edited

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: KAHAE FCC AKA ALOHA KEIKI DAY CARE
FACILITY NUMBER: 426215464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the stairway was accessible to the children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2022
Plan of Correction
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Licensee agrees to add a barrier to the stairway to make the stairway inacessible to chidlren in care. Licensee agrees to submit a picture of the stairs being inacessible to children in care by 6/17/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2022
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: KAHAE FCC AKA ALOHA KEIKI DAY CARE
FACILITY NUMBER: 426215464
VISIT DATE: 06/10/2022
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LPA then observed Licensee purchase a new fire extinguisher via Amazon and will arrive at the beginning of next week. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill documentation. The last drill was completed on 1/20/22.

The outdoor play yard is completed fenced. LPA notes that the yard affords plenty of shade for the children. Filtered drinking water is available to children by means of individual water bottles. Toys, furniture and equipment observed in the yard are age appropriate. LPA observed no bodies of water on site.

A sampling of the children's records were reviewed. The records are current, complete and possessed emergency contact information. The Licensee's records were also reviewed and found to be complete. Licensee’s Pediatric CPR and First (EMSA approved) expires 10/23/22 and Mandated Reporter certificates expires 8/1/23.

The Licensee notes no firearms or ammunition are stored on site.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes 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

Licensee 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.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: KAHAE FCC AKA ALOHA KEIKI DAY CARE
FACILITY NUMBER: 426215464
VISIT DATE: 06/10/2022
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Today, Type B citation was issued.

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

Exit interview and report was reviewed with the licensee,Theresa Anne Kahae.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC809 (FAS) - (06/04)
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