426215980-7-29-2020-17-CC-FVEZ-BRYTB5-20200729143435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215980
Report Date: 07/28/2020
Date Signed: 07/29/2020 02:35:13 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:	CHAVEZ FCC AKA LINDA'S CHILD CARE		FACILITY NUMBER:	426215980
ADMINISTRATOR:	HERLINDA CHAVEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 868-6405
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	14	CENSUS: 0	DATE:	07/28/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Herlinda Chavez		TIME COMPLETED:	05:07 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	On 7/28/20 at 3pm, Licensing Program Analyst Francisca Velazquez conducted an announced Pre-Licensing – change of location Tele-Inspection with applicant, Herlinda Chavez. Due to COVID-19 and Department of Public Health guidelines of social distancing, the tour of the home (inside and outside) was conducted via WhatsApp video meeting. The inspection was held in Spanish by LPA Velazquez. This is a one story, three (3) bedroom and two (2) bathroom home. The bedrooms and one bathroom are off-limits and are made inaccessible to children by door lock knobs on each door. The laundry room is also off-limits and is made inaccessible by gate. LPA reminded applicant that the gate must be secured at all times when children are present. Applicant stated that child care services will be provided in the home Monday-Sunday, 24 hours a day. LPA observed the indoor activity area in the living room and the required documents (including information about COVID19) posted on the wall. LPA observed couches, mats for children to sleep on and a few age appropriate toys and child size furniture accessible. Applicant noted that she will be adding more furniture and material once she completely moves out of her current home. The bathroom to be used by children contains a toilet and sink and was observed to be clean and free of toxins and cabinet under sink has safety latches on. In the kitchen, LPA observed that knives are stored out of reach of children in the wall mounted cupboard, all drawers had safety latches and stove had safety knobs. LPAs observed the 2 A10 BC Fire Extinguisher which was serviced on 7/20/20. The home is equipped with a working smoke detector and carbon monoxide detector that were tested at 3:20 pm and found to be working properly. There are sliding glass doors which lead out of the kitchen and dining room area into the outdoor area which is completely fenced. There is a locked storage shed where all of the cleaning supplies are stored. There are no bodies of water and plenty age appropriate toys or furnishings for children outside. Applicant stated that there are no guns and/or ammunition in the home. Continued

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
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: CHAVEZ FCC AKA LINDA'S CHILD CARE	FACILITY NUMBER: 426215980
	VISIT DATE: 07/28/2020

NARRATIVE

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Applicant is the only adult that will be living in the home and has had her criminal record and TB clearance. Applicant has met the immunization requirement per SB 792 and will complete Mandated Reporter Training for Child Care Providers (AB1207) on 8/1/2020 and will submit proof of completion certificate to LPA. Pediatric CPR/first aid is current (expires 2/18/21).

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 discussed the following information with applicant and provided written information via email:
Sudden Infant Death Syndrome/Safe Sleep guidelines, Shaken Baby Syndrome, and COVID-19 guidelines. The “Effects of Lead Exposure” brochure is to be distributed to all families at time of enrollment. It is the Applicant's responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. LPAs informed applicant that she can subscribe to receive Provider Information Notices (PINs) from Community Care Licensing Division via www.ccld.ca.gov.

Exit interview was conducted by LPAs with Applicant, Herlinda Chavez via WhatApp at 5:09 pm.This report was read and explained in Spanish by LPA Velazquez. This report along with a copy of, LIC624b, LIC311d and Lead information will be emailed to the Applicant today.

The home meets Title 22 Division 12 requirements for a large Family child Care home license. Effective date of license will be 7/30/20.

LPAs requested that Applicant reply to the email within 24 hours to confirm receipt of the attached report and documents.

A Notice of Site Visit was forwarded to the Licensee for posting (LIC 9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required may result in a $100.00 civil penalty.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
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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