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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215870
Report Date: 01/02/2020
Date Signed: 01/02/2020 01:19:53 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:LARA FAMILY CHILD CAREFACILITY NUMBER:
426215870
ADMINISTRATOR:MARIA ELENA LARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 867-3744
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 1DATE:
01/02/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Maria Elena LaraTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Martina Jimenez made a PRE-LICENSING visit to the home. LPA met with applicant, Maria Elena Lara. A tour of the home was made both inside and outside. The applicant will use the living room, dinning room, kitchen, Master bedroom Master bathroom and hall bathroom for the day care.

The regulation fire extinguisher was purchased on December 5, 2019. Applicant is reminded to service or purchase the fire extinguisher yearly. The smoke detector was tested and found to be operational. The play area is completely fenced. Applicant's 1st Aid/CPR certificates are valid until September 20.2021.

Applicant does not have any guns or weapons. LPA did not observe any bodies of water. Applicant states that she does not have liability insurance. LPA informed applicant that she will need parents to sign a waiver for the liability insurance (applicant was provided form). LPA reviewed rental agreement during the visit.


THIS REPORT CONTINUES ON LIC 809C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020
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: LARA FAMILY CHILD CARE
FACILITY NUMBER: 426215870
VISIT DATE: 01/02/2020
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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 within 30 days of admission. 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.

LPA discussed with Maria Elena Lara, applicant and gave applicant a packet of updated samples of state required forms to be kept in the children's file, required forms to be posted and forms that needs to be maintained at the FCCH. LPA also discussed and provided information about Sudden Infant Death Syndrome/Safe sleep, and Capacity requirements.

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, exersaucers, or any similar article are not permitted on the premises during day care hours.



The home will be Licensed once Applicant submits verification of the following:

1. Door knob covers on bedroom #2, bedroom #3 and garage doors.
2. Carbon monoxide receipt/purchase and photo
3. Applicant is to make the following items in the Master bedroom and Master bathroom areas inaccessible to children (lotions, perfumes, nail polish, deodorant, hair care products, ect)

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. License is pending the above corrections.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020
LIC809 (FAS) - (06/04)
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