426215839-12-16-2021-17-CC-SMCA-C9RSZT-20211216131939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215839
Report Date: 12/16/2021
Date Signed: 12/16/2021 01:20:09 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 AKA LITTLE ANGELS DAY CARE		FACILITY NUMBER:	426215839
ADMINISTRATOR:	LUIS CARLOS AYALA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 291-2029
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 6	DATE:	12/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Luis Ayala and Maria Juarez		TIME COMPLETED:	01:25 PM

NARRATIVE

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A Required 1 Year Inspection was conducted by LPA S. Mendoza-Ceja and D. Thompson who met with Licensee Luis Ayala. The home was toured inside and outside. The home was observed to be clean and orderly. Licensee stated there are no firearms/ammunition or bodies of water on the premises. LPA did not observe any hazards during the visit. There is an operating smoke detector and carbon monoxide detector in the home. There is a 2 A10 BC Fire Extinguisher in the home, receipt dated 10/30/2020.

Licensee did not have verification of a fire drill being conducted or documented as required. LPAs reviewed children's records, including the child care roster and found to be complete. LPAs reviewed and provided handouts Individual Infant Sleeping Plan LIC9227, Infant Sleep Chart, 102425 Infant Safe Sleep Regulations, and Safe Sleep - Frequently asked Questions. LPAs reviewed current CPR and First Aid for Licensee Luis Ayala, Maria Juarez, and Wendy Ayala (expires 07/29/2023 ). Child Abuse Mandated Reporter Training is current for all three care providers (expire 10/2022). LPA reviewed the requirement for care providers/employees and volunteers to obtain immunization against Influenza, Pertussis, and Measles. Verification was reviewed for all three care providers.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

The following Type B deficiencies are cited according to CCR, Title 22, Division 12 are cited on the following pages. Appeal Rights were reviewed and provided.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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 4

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 AKA LITTLE ANGELS DAY CARE	FACILITY NUMBER: 426215839
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above the 2A10 BC Fire Extinguisher was purchased on 10/30/2020. The fire extinguisher was not serviced or replaced yearly as required which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/20/2021
	Plan of Correction
1 2 3 4	Licensee shall purchase or service 2 A10 BC Fire Extinguisher and submit verification to Licensing for review by 12/20/2021.

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. Licensee stated fire drills were not conducted which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/20/2021
	Plan of Correction
1 2 3 4	Licensee shall conduct a Fire drill and disaster drill and submit verification to Licensing for review by 12/20/2021.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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 AKA LITTLE ANGELS DAY CARE	FACILITY NUMBER: 426215839
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)1

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. Licensee stated fire drills have not been documented which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/20/2021
	Plan of Correction
1 2 3 4	Licensee shall document a Fire drill and disaster drill and maintain document on file. Please submit verification to Licensing for review by 12/20/2021.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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 AKA LITTLE ANGELS DAY CARE	FACILITY NUMBER: 426215839
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(10)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when two exersaucers were observed in the home which are prohibited equipoment in licensed day care homes. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/17/2021
	Plan of Correction
1 2 3 4	Licensee shall remove the items from the home by 12/17/2021.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4