426215990-9-23-2020-17-CC-LVIA-BTQR84-20200923124720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215990
Report Date: 09/23/2020
Date Signed: 09/23/2020 12:47:39 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:	BAUTISTA FAMILY CHILD CARE		FACILITY NUMBER:	426215990
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	09/23/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Jeannette Bautista		TIME COMPLETED:	09:40 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	On September 23, 2020 at 9:05 AM, Licensing Program Analyst (LPA) Laura Villanueva conducted an announced tele-visit for the purpose of performing a pre-licensing inspection. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPA Villanueva conducted the tele-inspection via FaceTime and met with Licensee Jeannette Bautista. During this tele-inspection the applicant took LPA Villanueva on a virtual tour of the home. Applicant applied for a small family child care license. Family members residing in the home are two adults and 2 children. All areas identified on the facility sketch were inspected. This is a 2-story home which consists of three bedrooms, 3 full bathrooms, living room, family room, kitchen, and dining room, garage and backyard. The living room will be the primary child care room. 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 the backyard to be safe and almost fully fenced in. There is an area by the driveway that is open at the present time. Applicant stated that she will be installing a door to cover that opening soon. LPA suggested that applicant enroll in the food program. If food is not provided and food is brought from the children’s homes; containers shall be labeled with child’s name and properly stored or refrigerated. The fireplace in the living room is screened off to children. Knives are in a top cabinet in the kitchen making them inaccessible to children. The required (2A100BC) fire extinguisher was not present. Applicant has a B-436738 fire extinguisher. LPA informed Applicant that she needs to purchase the required fire extinguisher. Continued on LIC 809C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020

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: BAUTISTA FAMILY CHILD CARE	FACILITY NUMBER: 426215990
	VISIT DATE: 09/23/2020

NARRATIVE

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Smoke detectors and carbon monoxide detectors throughout the home are in operable condition. Per Applicant there are no weapons, firearms in the home. The Applicant has current Pediatric First Aid and CPR that expires 6/25/22. Applicant has proof of immunization against influenza, pertussis, and measles. Applicant has taken the Mandated Reporter Training on 5/26/20. Preventative Health and Safety course was taken 2/21/20.

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a 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 and maintained for a period of three years, even after children no longer are 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 should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your 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 was 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.

Continued on LIC 809C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020

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: BAUTISTA FAMILY CHILD CARE	FACILITY NUMBER: 426215990
	VISIT DATE: 09/23/2020

NARRATIVE

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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 Departments right to inspection 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.

Continued on LIC809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020

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: BAUTISTA FAMILY CHILD CARE	FACILITY NUMBER: 426215990
	VISIT DATE: 09/23/2020

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

A probational small family child care licensee will be granted as of today 9/23/20. Applicant will complete the following before a permanent child care license is issued.

A lock will be placed on the indoor garage door making it inaccessible to children.
Cabinet under sink in the bathroom will be secured.
The required 2A10BC or larger fire extinguisher will be purchased with proof of purchase date.
A gate will be placed as a barrier to the driveway and the backyard to keep children in yard.

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. Applicant agreed to receive a copy of report via email and voiced understanding that the read receipt confirmation from email will be in lieu of her signature once she received the report.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020

LIC809 (FAS) - (06/04)

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