426215913-1-21-2020-17-CC-MKST-BL2NYN-20200121095300

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215913
Report Date: 01/21/2020
Date Signed: 01/21/2020 09:53:14 AM

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:	VIVAR FAMILY CHILD CARE		FACILITY NUMBER:	426215913
ADMINISTRATOR:	PATRICIA VIVAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 598-8112
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	14	CENSUS: 0	DATE:	01/21/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Patricia Vivar		TIME COMPLETED:	09:55 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), Melissa Stewart, conducted an announced Pre-Licensing Inspection and met with Patricia Vivar. The home was toured inside and out. This is a 3 bedroom and 2 bath home. LPA observed clean, safe, age appropriate toys in the indoor activity area which is located in the living room. All hazardous items are stored inaccessible to children in care. The bathroom used by children was observed to be clean and free of toxins. The three bedrooms, en suite bathroom and garage are off limits and are made inaccessible by child proof door knob locks. The outdoor activity area is completely fenced and is equipped with toys, small slide and tree house which has a locking gate at the base of the stairs. Applicant owns a dog with required vaccinations. Applicant stated there are no guns or ammunition in the home. No bodies of water were observed. Applicant has met immunization requirement per SB 792, Pediatric CPR/first aid is current (expires 4/20/20) and AB 1207 Mandated Reporter Training was completed on 11/26/19. Applicant is enrolled in a Preventative Health and Safety course scheduled for 2/20/20. The home was inspected by the Santa Maria Fire Department and granted a Fire Clearance on 12/30/19. LPA observed the 2 A10 BC Fire Extinguisher which was serviced on 12/10/19. Applicant was reminded to service or replace the Fire Extinguisher yearly. The home is equipped with working carbon monoxide detector and smoke detector. Lease/Mortgage statement was reviewed. Applicant states that she does not yet have liability insurance. LPA informed applicant that she will need parents to sign a waiver for the liability insurance (applicant was provided form). Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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: VIVAR FAMILY CHILD CARE	FACILITY NUMBER: 426215913
	VISIT DATE: 01/21/2020

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

LPA provided Pre-licensing packet to applicant, reviewed and issued updated samples of state required forms in English and in Spanish to be posted or retained in each child’s file. LPA reviewed and provided applicant with a copy of “Safe to Sleep” brochures in English and Spanish. LPA provided “Effects of Lead Exposure” brochure to be distributed to all families. Applicant was made aware 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. LPA assisted applicant to sign up to receive important updates regarding the regulations for Family Child Care Home via email.

The home meets all requirements of Title 22 Division 12 for a Large Family Child Care Home.

Provisional license is effective today, 1/21/20. Provisional license will expire in 90 days, if copy of Preventative Health and Safety course is not submitted on or before 4/20/20.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2