426215508-5-3-2023-17-CC-GRES-CRGNUU-20230503104655

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215508
Report Date: 05/03/2023
Date Signed: 05/03/2023 10:47:10 AM

Document Has Been Signed on 05/03/2023 10:47 AM - 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:	GREENE FAMILY CHILD CARE		FACILITY NUMBER:	426215508
ADMINISTRATOR:	JENNIE GREENE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 717-8725
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 2	DATE:	05/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jennie Greene		TIME COMPLETED:	10:53 AM

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 May 3rd, 2023 at 9:00 AM, Licensing Program Analysts Gigi Reyes and Dixie Wright conducted an unannounced One (1) Year Required inspection at a Family Child Care Home (FCCH) owned and operated by Jennie Greene. LPAs discussed the purpose of the inspection with the licensee. The inspection was conducted to evaluate the facility's compliance with the licensing regulations and Health and Safety Code. During the inspection, LPAs and Licensee toured the interior and exterior of the facility. There was one child and one infant present. LPAs observed that required licensing forms were posted on the wall in the back playroom. Smoke and carbon monoxide detector was observed, tested and operational. The regulation fire extinguisher was serviced on 06/22/2022 and current. The facility conducts and documents fire and disaster drill every six months or when there is a new enrollment, and the last drill was conducted on 2/14/2023. The bathroom is free of toxins. Cleaning compounds and knives are kept inaccessible to children in care. The backyard of the FCCH was enclosed with a wooden fence, chain link fence and brick fence and equipped with age appropriate toys and equipment. No bodies of water were observed on site. The licensee stated that there were no guns or ammunition in the home. LPAs reviewed the facility file and found that the Pediatric CPR and First Aid certificate expires on 06/23/2023. The licensee renewed the Mandated Reporter Training Certificate, which expires on 03/07/2025. LPA reminded the licensee that AB 1207 should be renewed every two years. The licensee has complete immunization and TB record in file. Continued on LIC 809C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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: GREENE FAMILY CHILD CARE	FACILITY NUMBER: 426215508
	VISIT DATE: 05/03/2023

NARRATIVE

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The FCCH has a current roster of children in care, and a sampling of children records were reviewed and found to be current. The facility file contains Emergency and Identification card requirements. However, the licensee has liability insurance. LPA observed that an Individual Infant Sleep Plan (LIC9227) is maintained in the FCCH, and the licensee physically checks and documents the condition of the sleeping infant every 15 minutes.

Licensee does not provide 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.

Continued on LIC 809C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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: GREENE FAMILY CHILD CARE	FACILITY NUMBER: 426215508
	VISIT DATE: 05/03/2023

NARRATIVE

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LPAs 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 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.

Licensee was reminded that all adults 18 year old 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, no deficiency was cited. Appeal Rights were given and discussed.
Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted and report was reviewed with the licensee, Jennie Greene.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC809 (FAS) - (06/04)

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