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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215473
Report Date: 07/18/2022
Date Signed: 07/18/2022 01:08:45 PM


Document Has Been Signed on 07/18/2022 01:08 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:PAZ FAMILY CHILD CAREFACILITY NUMBER:
426215473
ADMINISTRATOR:JOSEFINA PAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 268-3217
CITY:GUADALUPESTATE: CAZIP CODE:
93434
CAPACITY:14CENSUS: 4DATE:
07/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Josefina PazTIME COMPLETED:
01:15 PM
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On 7/18/22, at 10:30 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Josefina Paz, Licensee of the FCCH and explained the purpose of the inspection. LPA notes COVID Pre-screening questions were asked of Licensee prior to the inspection. The Licensee's responses suggest the FCCH is void of COVID positive cases. At the time of the inspection, LPA observed four children on site.

LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH’s living room, dinning room, one (1) bedroom, bathroom and outdoor yard used for childcare services. While two (2) bedrooms and garage are inaccessible to children in care. LPA observed both bedrooms and garage have an additional safety lock to ensure areas are inaccessible.

The FCCH was observed to be clean and orderly. The FCCH has ventilation to afford for the children’s comfort. The FCCH was void of hazardous items. Medication is stored in an elevated cabinet in the FCCH's kitchen and Licensee’s master bedroom, while sharps are also observed in an elevated cabinet in the kitchen. Cleaning compounds in the FCCH are stored in an elevated cabinet in the kitchen and the garage. The bathroom used for child care is clean and free of toxins. LPA observed an open face heater in the living room, Licensee communicated that open face heater is not used at all. Toys, furniture and equipment in the FCCH are age appropriate.

Required forms are predominantly posted on the wall of the FCCH. LPA observed both smoke and carbon monoxide detectors in the FCCH. The detectors were tested at 11:29 AM and found to be operable. The FCCH has a regulation fire extinguisher on site which was service on 5/17/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
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: PAZ FAMILY CHILD CARE
FACILITY NUMBER: 426215473
VISIT DATE: 07/18/2022
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The backyard has cement play area which are enclosed by wood fencing. The fence’s entry/exit gates are secure. Shade is provided by means of a canopy. Toy’s furniture and play equipment observed in backyard area are age appropriate and in satisfactory condition. Licensee is reminded to replace toys and equipment in the outdoor area when items start to degrade or are not in good repair. LPA observed no bodies of water on site.

LPA reviewed children's records. The records are current, complete and possessed emergency contact information and immunization records. Licensee has documentation memorializing child sleep checks in intervals of 15 minutes. A review of the FCCH's fire drill log shows the last drill occurred on 5/6/22. The Licensee's records are also current and complete with pediatric CPR and First Aid certifications expiring on 5/14/23. Licensee’s Mandated Reporter training certificate is valid until 5/15/24. Licensee is reminded to renew certifications and training prior to expirations. The Licensee informed LPA 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 for additional resource. LPA also informed Licensee 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. LIC 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
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: PAZ FAMILY CHILD CARE
FACILITY NUMBER: 426215473
VISIT DATE: 07/18/2022
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A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Josefina Paz.

Today’s inspection and review of report was conducted in Spanish due to Spanish being the Licensee’s primary language.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC809 (FAS) - (06/04)
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