426215977-10-20-2020-17-CC-MJIZ-BUKM7J-20201020092138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215977
Report Date: 07/28/2020
Date Signed: 10/20/2020 09:22:09 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:	AYALA FCC AKA EL SHADDAI DAYCARE		FACILITY NUMBER:	426215977
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	07/28/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Nancy Ayala		TIME COMPLETED:	04:45 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	This was a pre-licensing inspection conducted by Martina Jimenez, Licensing Program Analyst (LPA) due to COVID-19 and precautionary measures. This pre-inspection was conducted with Nancy Ayayla, applicant via a tele-inspection in Spanish by use of Face-time. During this tele-inspection the applicant took LPA on a tour of the home. During this tour the following was noted: Applicant applied for a Small Family Child Care license. Family members residing in the home are 5 adults. Per Applicant, her operating hours will be Monday through Saturday from 5:00 a.m. to 5:00 p.m. Applicant states she wants to care for children from birth to 12 years of age. All areas identified on the facility sketch were inspected. This is a single-story home which consists of five bedrooms, three restroom, living room, kitchen, dining room/child care area and completely fenced backyard. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed backyard outdoor play area to be safe with age appropriate toys, play structure, games etc. Backyard is adequately fenced. There are no bodies of water observed. Off limit areas included: five bedrooms, two bathrooms and front yard. LPA observed child safety gates in the kitchen making two bedrooms and one bathroom inaccessible to children. LPA observed safety locks located in the children’s bathroom and kitchen. Areas used by children included: kitchen, dining room, living room/dining room, hallway bathroom and backyard. Continues on LIC 809C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020

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: AYALA FCC AKA EL SHADDAI DAYCARE	FACILITY NUMBER: 426215977
	VISIT DATE: 07/28/2020

NARRATIVE

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The applicant states that she will provide food for children in care. There are age appropriate toys and napping equipment on the premises. Knives are stored out children’s reach, inaccessible to children. The required fire extinguisher 2A10BC was purchased in July 28, 2020. Smoke detector was tested at 3:09 PM and was functioning at the time of the visit. The carbon monoxide detector was tested at 2:37 PM and was functioning at the time of the visit. Per Applicant, there are no weapons, firearms in the facility. First Aid and emergency kits are available. The Applicant has current Pediatric First Aid and CPR which expires, March 7, 2022. Applicant took the Preventative Health on February 12, 2020. Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles.

The following was discussed with the applicant:
· Individuals who are 18 years of age or older living in the home or working in the home, must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain the Criminal Record Background Check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunizations, and a valid criminal record clearance associated to the facility license.
· A current roster of children enrolled must be available for review and maintained for a period of three years, even after children are no longer attending the facility.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
· Changes in the home should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if applicant moved to another location/ home.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements were reviewed and explained.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a Family Child Care Home, 24/7.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
Continues on LIC 809C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020

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: AYALA FCC AKA EL SHADDAI DAYCARE	FACILITY NUMBER: 426215977
	VISIT DATE: 07/28/2020

NARRATIVE

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· No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

· All adults living and working in the home shall be made of aware of the Department inspection rights authority.

During this visit, the LPA reviewed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) with the applicant. LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

LPA advised the applicant to sleep infants where they can always be directly supervised. LPA also advised against sleeping infants in a separate room.

Forms to be posted
LIC6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License

Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse,
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).

Children’s records requirements: LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children in Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

Continues on LIC 809 C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020

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: AYALA FCC AKA EL SHADDAI DAYCARE	FACILITY NUMBER: 426215977
	VISIT DATE: 07/28/2020

NARRATIVE

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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.

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

Exit interview was conducted with Nancy Ayala, applicant, via tele-inspection. This report will be sent to the Applicant via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature.

Based on the LPA’s observation, the following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 8/10/2020.

1. Verification Applicant completed the Mandated Reporter Training per AB 1207

2. Photos verification of bedrooms 1, 2, & 3 inaccessible to children in care.

3. Photo verification of the gallon of paint and the five gallon container with unknown liquid removed from children's play area.

4. Per applicant; an updated Application (LIC 279) removing Angelica Maria Martinez, applicant's mother from co-applicant to an adult living in the home.

A small family child care licensee will be granted upon receipt of proof of corrections. Once licensed, the applicant is required to comply with the terms and limitations stated on the license. A copy of this report was reviewed and provided to the applicant.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020

LIC809 (FAS) - (06/04)

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