426215839-9-10-2019-17-CC-SMCA-BFVQSZ-20190910122621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215839
Report Date: 09/10/2019
Date Signed: 09/10/2019 12:26:34 PM

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:	AYALA FAMILY CHILD CARE		FACILITY NUMBER:	426215839
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	09/10/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Luis Ayala		TIME COMPLETED:	12:30 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	Licensing Program Analysts (LPAs) S. Mendoza-Ceja and C. Patterson met with Luis Ayala for the purpose of conducting a prelicensing inspection. Mr. Ayala stated the hours of operation will be Monday through Friday from 7am through 5 pm. The entire home was toured inside and outside. Mr. Ayala stated the living room, sun room, kitchen, # 1 bedroom, and hallway bathroom for day care children. The backyard was also inspected which includes the covered patio, grass area, and side yard which is completely enclosed by a fence. Mr. Ayala stated there are no bodies of water, no firearms, nor ammunition in the home. Mr. Ayala stated the 2nd living room will be used only as a walkway to get to the backyard. The off limit areas include the 3 bedrooms which were made inaccessible by baby gates, the garage which is secured by a plastic door knob cover. LPAs did not observe any bodies of water. There is a 1 A10 BC Fire Extinguisher in the home. Applicant is reminded to service or purchase the fire extinguisher yearly. There is a dual carbon monoxide/smoke detector which was tested and found functional. Luis Ayala, Maria Santos Juarez, and Wendy Ayala have completed Preventative Health and Safety, including 1st Aid/CPR certificates (expire 06/22/21). The lease agreement was reviewed for the home. LPAs reviewed children's record keeping requirements. Mr. Ayala states that she does not have liability insurance. LPA informed applicant that he will need parents to sign a waiver for the liability insurance (applicant was provided form). LPAs reviewed and discussed the "Safe Sleep in Child Care, Child Care Provider's Guide to Safe Sleep, and Effects of Lead Exposure" handouts were provided to applicant. LPAs also reviewed and discussed the family pet/puppy (license/vaccines current) in the home.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: AYALA FAMILY CHILD CARE	FACILITY NUMBER: 426215839
	VISIT DATE: 09/10/2019

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
26
27
28
29
30
31
32

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.

Prior to licensure the following will need to be completed:
1. AB 1207 Child Abuse Mandated Reporter Training for Luis Ayala, Maria Santos Ayala, and Wendy Ayala.
2. Child Abuse Clearance for adults in the home.
3. Obtain 2A10 BC Fire Extinguisher for the home.
4. Organize the 1st livingroom for day care children with toys and equipment.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2