426215977-12-16-2021-17-CC-MJIZ-C9QQDZ-20211215110533

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215977
Report Date: 12/15/2021
Date Signed: 12/16/2021 10:18:09 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: 0	DATE:	12/15/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Nancy Ayala		TIME COMPLETED:	11:20 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	THIS IS AN AMENDED REPORT FOR INSPECTION CONDUCTED ON 12/15/2021 Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site. On 12/15/21, at 9:35 AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Case Management inspection of the above referenced Family Child Care Home (FCCH) for a change of capacity. LPA met with Nancy Ayala, Licensee of the FCCH and explained the nature/purpose of the inspection. During this inspection, LPA and Licensee together toured the an interior and exterior of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins at the time of the visit, which would pose a danger to the children in care. LPA observed no children in care at the time of the inspection. LPA reviewed the Licensee’s First Aid/ CPR certification which expires on 3/7/2023. LPA observed a regulation fire extinguisher which was serviced on 6/5/2021. LPA reviewed the Licensee’s Mandated Reporter Training certificate, which was completed on 01/03/2020. This Report Continues on LIC 812C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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: 12/15/2021

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THIS IS AN AMENDED REPORT FOR THE INSPECTION CONDUCTED ON 12/15/2021

On 9/20/21, the Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 12/10/2021.

LPA observed that COVID-19 documents were posted. LPA reviewed with Licensee the Safe Sleep Regulation. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov. Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

The home meets Title 22 of CCR requirements for a Large Family Child Care license effective date of license is today, December 15, 2021. LPA provided the Licensee a Notice of Site Visit (LIC 9213) to be posted.

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

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