426215866-10-17-2019-17-CC-GRES-BH2QM7-20191017121700

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215866
Report Date: 10/17/2019
Date Signed: 10/17/2019 12:17:40 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:	CORREA FAMILY CHILD CARE		FACILITY NUMBER:	426215866
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/17/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Esperanza Correa		TIME COMPLETED:	10:50 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	Licensing Program Analyst (LPA) Gigi Reyes conducted an announced Pre Licensing inspection and met with applicant Ms. Esperanza Correa. The home was toured inside and outside. The home is a two story with 5 bedrooms and 4 bathrooms. The bedrooms, upper level of the home and garage are not accessible to children. The living room will be used for indoor day care activities. The backyard is completely fenced. Applicant stated there are no guns nor ammunition in the home. Nobodies of water were observed. CPR and first aide expires on on 8/13/2021, Fire Extinguisher was serviced on 1/2/2019. Preventive Health Training was completed on 8/9/2019. Applicant has complete record of immunization. There is a working carbon monoxide and smoke detector in the home. Applicant is not providing Incidental Medical Services (IMS). 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 Continued on 809 C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: CORREA FAMILY CHILD CARE	FACILITY NUMBER: 426215866
	VISIT DATE: 10/17/2019

NARRATIVE

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LPA reviewed required forms to be kept in the children's file, required forms to be posted and forms that need to be maintained at the FCCH and capacity requirements. LPA discussed and provided information about Sudden Infant Death Syndrome/Safe sleep (Spanish version). LPA also discussed and provided Effects of Lead Exposure pamphlet to be provided to each family.

Applicant was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. Also, Applicant was reminded that baby walkers, jumpers, bouncers, exer saucer, or any similar article are not permitted on the premises during day care hours.

The License is pending subject for Manager's approval.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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