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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215985
Report Date: 08/25/2021
Date Signed: 08/25/2021 01:50:54 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:PEREZ FCC AKA HARMONY AND JUBILEEFACILITY NUMBER:
426215985
ADMINISTRATOR:MAINOR QUEVEDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 455-0516
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 4DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Maria PerezTIME COMPLETED:
02:00 PM
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On 8/25/21 at 12:20 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Required Inspection of the facility. Prior to entering the facility, LPA conducted pre-screening COVID-19 questionnaire and based on Licensee’s responses it was determined that the facility is safe and free from any COVID-19 exposures. LPA meet with Maria Perez, Licensee of the facility and explained the purpose of the inspection. LPA in the company of the Licensee, toured the interior and exterior of the home. This home consists of three (3) bedrooms, two (2) bathrooms, kitchen/dining area, living room, day-care room, covered indoor patio, small studio, garage and backyard. Licensee stated that living room, day care room, kitchen/dining area, bathroom and backyard are accessible to the children in care. Licensee also stated that children walk through the covered indoor patio to get to the backyard. Licensee stated that children are always supervised when walking through the covered indoor patio. All bedrooms, one bathroom, studio and garage are inaccessible to the children in care. During the time of the inspection, Licensee was caring for four (4) children.

LPA observed required forms posted in the wall as you enter the facility. LPA observed a smoke and carbon monoxide detectors in the hallway of the facility. Both detectors were tested by Licensee and were operational at 12:38 PM. The home has a regulation fire extinguisher which was serviced on 10/6/20. LPA reminded Licensee that fire extinguisher needs to be either service or purchase annually. The home maintains working telephone services. LPA observed a fireplace in the living room that is covered and inaccessible to children in care.

LPA observed all cleaning supplies and toxins are stored in the garage that is inaccessible to children in care. LPA observed that Licensee stores sharps in a high cabinet in the kitchen that are inaccessible to children in care. The facility is orderly, clean and has ventilation for child care services. The restroom used for children was found to be clean and orderly and has plenty of hand soap, paper towels and hand washing poster for children. Medication in the facility is stored in a high cabinet in the kitchen are inaccessible to children in care. Toys and equipment observed in the facility are age appropriate. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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: PEREZ FCC AKA HARMONY AND JUBILEE
FACILITY NUMBER: 426215985
VISIT DATE: 08/25/2021
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Licensee stated that children have access to the backyard. Licensee shared that when children play outdoors, they are always supervised by an adult. LPA observed plenty of gross motor activities and plenty of shade for the children in care. LPA discussed cleaning large gross motor equipment frequently to avoid for spiders or spider webs. LPA observed three (3) sheds in the backyard that are locked and inaccessible to children in care. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the facility.

A sampling of the children's record was reviewed and found to have current and up to date with emergency information cards and personal rights. The Licensee's records indicate Mandated Reporter training certificate expires 7/9/22. LPA reminded Licensee that AB1207 must be updated every two years. Licensee’s CPR and First Aid certifications expires on 9/14/22. LPA review emergency drill log and observed the last emergency drill was conducted and documented today 4/8/21. LPA reminded Licensee that emergency drills are required every six (6) months and need to be documented. LPA reviewed vaccination's for canines Rango and Jay and both canines are up to date with vaccination's. Jay's next vaccine is due 10/30/23 and Rango's next vaccine is due 1/16/24.



The Licensee is not providing 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: www.ada.gov/childqanda.htm

LPA discussed COVID 19 guidance and best practices with the Licensee. Licensee was reminded that it is Licensee's responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. LPA and Licensee discussed safe sleep regulations. Licensee is aware of the new safe sleep regulations. Licensee currently has infant age children enrolled for services. All infants have LIC 9227 and 15 minute log accessible for review.

In areas evaluated, there were no deficiencies cited during today's visit.

LPA provided Licensee with Notice of Site visit (LIC 9213) which was posted by the Licensee.

Today's inspection and review of report was conducted in Spanish with Licensee, Maria Perez.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
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