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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215980
Report Date: 11/21/2024
Date Signed: 11/21/2024 12:40:01 PM

Document Has Been Signed on 11/21/2024 12:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CHAVEZ FCC AKA LINDA'S CHILD CAREFACILITY NUMBER:
426215980
ADMINISTRATOR/
DIRECTOR:		HERLINDA CHAVEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 868-6405
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/21/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:41 AM
MET WITH:Herlinda Chavez TIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
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On November 21, 2024 at 9:41AM, Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Required - 3 Year inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with Licensee Herlinda Chavez and informed them the purpose of the inspection. At the time of the inspection 7 children and 2 assistants were present.

LPA in the company of the Licensee toured the interior and exterior of the FCCH. LPA observed the living room area to have sufficient ventilation and equipment for children in care. LPA observed the kitchen to be accessible to children and that all lower cabinets and drawers are secured with child proof locks. LPA observed cleaning compounds to be secured under the kitchen sink. LPA observed sharps and medication to be stored in an elevated kitchen cabinet. LPA observed the bedrooms to be locked and inaccessible to children. LPA informed Licensee in order for areas to be inaccessible to children they must be secured at all times. LPA observed the bathroom to be used for children to be clean and free of hazards.

LPA observed the backyard to be completely enclosed and the exit/entry ways to be secured. LPA observed a play structure and other children's equipment that is free of hazards. LPA informed Licensee when equipment is no longer in good condition, they must remove them from the children's area. LPA observed a sandbox that had animal feces in it. 1 Type B deficiency is being issued on the attached LIC 809D as a result. LPA observed the backyard to have 2 storage sheds. LPA observed one to be locked and the other to be unlocked. LPA notes the unlocked storage shed did not contain hazardous items.

The FCCH has a smoke and carbon monoxide detector which was tested at 10:42AM and found in working order. LPA observed the FCCH to have a regulation fire extinguisher which was serviced on 4/23/2024. LPA reminded Licensee to either service or purchase a regulation fire extinguisher annually.

CONTINUED PAGE 2
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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 7
Document Has Been Signed on 11/21/2024 12:40 PM - It Cannot Be Edited


Created By: Giovani Gonzalez On 11/21/2024 at 11:30 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CHAVEZ FCC AKA LINDA'S CHILD CARE
FACILITY NUMBER: 426215980

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in not having the children's sandbox free of hazards which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2024
Plan of Correction
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Licensee will clean or remove sandbox from children's area. Licensee will provide proof of complettion to LPA via email at giovani.gonzalez@dss.ca.gov no later than 11/28/2024
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record , the licensee did not comply with the section cited above in not having conducted an emergency drill within the last 6 months which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2024
Plan of Correction
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Licensee will conduct a fire/disaster drill and document it the drill. Licensee will provide proof of complettion LPA via email at giovani.gonzalez@dss.ca.gov no later than 11/28/2024
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Tolentino
LICENSING EVALUATOR NAME:Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/21/2024 12:40 PM - It Cannot Be Edited


Created By: Giovani Gonzalez On 11/21/2024 at 11:30 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CHAVEZ FCC AKA LINDA'S CHILD CARE
FACILITY NUMBER: 426215980

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review , the licensee did not comply with the section cited above in 3 out of 3 care givers not having a current mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2024
Plan of Correction
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Assistants and Licensee will complete the mandated reporter training . Licensee will provide proof of certificates to LPA via email at giovani.gonzalez@dss.ca.gov no later than 11/28/2024
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 7 children files are missing LIC 627 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2024
Plan of Correction
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Licensee will complete the files with all necessary forms and documentation. Licensee will provide proof of complete files to LPA via email at giovani.gonzalez@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Tolentino
LICENSING EVALUATOR NAME:Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2024


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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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CHAVEZ FCC AKA LINDA'S CHILD CARE
FACILITY NUMBER: 426215980
VISIT DATE: 11/21/2024
NARRATIVE
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LPA reviewed a sampling of children's files. LPA observed 3 out of 7 children to be missing LIC 627 Consent for Emergency Medical Treatment. Further LPA observed all files to have forms to be incomplete. Licensee informed LPA they recently stopped doing infant safe sleep 15 minute checks since they were informed it only applied to infants under 1 year old. LPA informed licensee the 15 minute checks are for all infants ( under 24 months) and observed licensee in fact had recently stopped conducting them,. 1 Type B deficiency is being issued as a result on the attached LIC 809D. LPA reminded Licensee it is there responsibility to ensure all children files are current and complete. LPA reviewed both assistants and Licensee's files. LPA observed both assistants and Licensee to be missing a current Mandated Reporter Training certificate. 1 Type B deficiency is being issued on the attached LIC 809D. LPA notes staff and Licensee have current pediatric CPR/First Aid (Licensee completed 7/29/2023. LPA reminded Licensee that it is their responsibility to ensure all training and certifications are current. LPA observed the last documented fire drill was conducted on 2/05/2024. 1 Type B deficiency is being issued as a result on the attached LIC 809D. Licensee informed LPA there are no fire arms in the home.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
CONTINUED PAGE 3
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CHAVEZ FCC AKA LINDA'S CHILD CARE
FACILITY NUMBER: 426215980
VISIT DATE: 11/21/2024
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

4 Type B deficiencies were issued during the inspection.

Exit interview was conducted with licensee Herlinda Chavez and notice of site visit was given.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
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