426215705-4-7-2023-17-CC-MBRT-CQNSK8-20230407135619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215705
Report Date: 04/06/2023
Date Signed: 04/07/2023 01:57:02 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/07/2023 01:57 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:	MACIAS FAMILY CHILD CARE		FACILITY NUMBER:	426215705
ADMINISTRATOR:	LILIANA MACIAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 252-2839
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 10	DATE:	04/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:52 PM
MET WITH:	Liliana Macias		TIME COMPLETED:	03:01 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 April 6th, 2023, at 12:52PM Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with licensee Liliana Macias and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. At the time of the inspection there ten (10) children and three (3) staff. Hours of operation are Monday – Friday 7:30AM-5:00PM This is a one-story home with 3 (three) bedrooms and two (2) bathrooms, kitchen, living room, dining room, and outdoor play area. LPA observed all required documents posted in a prominent location. All three (3) bedrooms and one (1) bathroom were made inaccessible by locks. Children have access to living room, dining room, one (1) bathroom and outdoor play yard. Kitchen is off limits made inaccessible by a gate. Knives, poisons, combustibles, and any toxins that would post a threat to children have been rendered inaccessible. LPA observed home to be clean, orderly with ample ventilation. LPA observed age-appropriate toys, furnishings and equipment for care and supervision. Children’s bedding is stored separately, and LPA observed labeled cubbies for personal items. LPA observed a 2A10BC fire extinguisher with service date of August 16th, 2022, mounted on the wall in the kitchen readily accessible. Licensee advised to ensure the fire extinguisher is serviced or a new one in purchased every year. The last emergency drill was conducted on 1/18/2023. Individual carbon monoxide and smoke alarms were tested at 1:12PM and were functioning at the time of inspection. The play yard is enclosed with a fence and no bodies of water are present. LPA observed age-appropriate toys and equipment and ample shade. Licensee stated no firearms or ammunition are present on the property. Licensee stated no incidental medical services are being provided at this time. CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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: MACIAS FAMILY CHILD CARE	FACILITY NUMBER: 426215705
	VISIT DATE: 04/06/2023

NARRATIVE

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LPA observed the facility roster was current. A sampling of children records was reviewed and complete. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Licensee’s Pediatric CPR/First-Aid certificate is current and valid until 9/27/2023. Mandated Reporter certificate is current and valid through 4/26/2024.

Incidental Medical Services (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.

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.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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: MACIAS FAMILY CHILD CARE	FACILITY NUMBER: 426215705
	VISIT DATE: 04/06/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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.

No deficiencies have been cited during today’s inspection.

Exit interview conducted, report was reviewed with the licensee, copy provided.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

LPA provided Safe Sleep FAQ's and courtesy 15-minute Sleep Log, Employee Rights

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC809 (FAS) - (06/04)

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