426215738-3-22-2022-17-CC-FVEZ-CCRVEH-20220322162221

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215738
Report Date: 03/22/2022
Date Signed: 03/22/2022 04:22:36 PM

Document Has Been Signed on 03/22/2022 04:22 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:	TELL FCC AKA AVID ANGELS DAY CARE		FACILITY NUMBER:	426215738
ADMINISTRATOR:	KIANA NICOLE TELL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 478-9869
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	14	CENSUS: 1	DATE:	03/22/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Kiana Nicole Tell		TIME COMPLETED:	02:45 PM

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On March 22, 2022 at 2:20 PM, Licensing Program Manager (LPM) Maria Mueller and Licensing Program Analyst (LPA) Francisca Velazquez met with Licensee, Kiana Nicole Tell for an Informal Conference held via Zoom. The purpose of the conference was to discuss the adults listed in her application. On the original application dated 2/19/19, Licensee listed Roberto de Jesus Vazquez as Licensee’s partner that lived in the home.

On March 21, 2022, our office received the following documents from Licensee:

1. Updated LIC279/ Application for a Family Child Care Home License

2. Updated LIC610A/ Emergency Disaster Plan for Family Child Care Homes

3. Grant deed for home location at 305 South Scott Drive Santa Maria, Ca 93454

The following reporting requirement were discussed with the Licensee:

102416.2 Reporting Requirements:

(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).

(2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

LPM informed Licensee that all Unusual Incident Reports can be emailed to unusualincidentreportsDO17@dss.ca.gov

CONT 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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: TELL FCC AKA AVID ANGELS DAY CARE	FACILITY NUMBER: 426215738
	VISIT DATE: 03/22/2022

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102402 Revocation or Suspension of a License or Registration

(a) The Department shall have the authority to suspend or revoke any license for the following reasons:

(1) Violation by the licensee of any of the laws, rules and regulations governing family child care homes.

(2) Aiding, abetting, or permitting the violation of any of the laws, rules and regulations governing family child care homes.

(3) Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.

(4) The conviction of a licensee, or other person specified in Section 102369(b)(8), at any time during licensure, of a crime as defined in Sections 102370(b) and (c).

(5) Failure to comply with the requirements for training in preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, as specified in Health and Safety Code Section 1596.866.

Licensee understands that facility 427215738 will be placed on two (2) year required visits.

Licensee stated that it was brought up to her attention that her application was not updated, so Licensee decided to update the application and other licensing forms. Per Licensee, Roberto de Jesus Vazquez moved out at the end of October 2021. As of today, Licensee and Roberto are friends, they are not a couple. Licensee stated that she is the only adult living in Licensee's home and reported that Roberto does not live with Licensee.

Exit interview was conducted and review of report was reviewed with Licensee, Kiana Nicole Tell. Licensee understand that this report will be email to Licensee. Licensee agrees to sign the report and email back to LPA Velazquez at francisca.velazquez@dss.ca.gov/

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC809 (FAS) - (06/04)

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