426216160-10-12-2021-17-CC-FVEZ-C7QR7D-20211012124609

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216160
Report Date: 10/12/2021
Date Signed: 10/12/2021 12:46:18 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 FAMILY CHILD CARE		FACILITY NUMBER:	426216160
ADMINISTRATOR:	MARYPAZ PEREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 863-3416
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	14	CENSUS: 0	DATE:	10/12/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	MaryPaz Perez		TIME COMPLETED:	01:00 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 10/12/2021 at 9:30 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-Licensing – change of location Inspection of the facility. Prior to entering the facility, LPA conducted COVID-19 pre-screening questionnaire and based on Applicant’s responses it was determined that the home is safe and free of any COVID-19 exposures. LPA met with Applicant, MaryPaz Perez and daughter/assistant Jacqueline Vasquez Alvarado. At the time of this inspection, no children were present. Applicant submitted a change of location application on 7/19/2021. Applicant stated that home offers services Monday-Sunday for 24 hours. Applicant states that she provides services for children ages birth to twelve (12) years of age. LPA observed required documents (including information about COVID-19) posted on the wall by the entrance and throughout the day care areas. This is a two-story home consisting of five (5) bedrooms, five (5) bathrooms home, two (2) living rooms, dining room, kitchen, patio and day-care room, garage and outdoor backyard. Applicant stated that the following areas will be accessible to children in care; day care room, one (1) living room, one (1) bedroom, one (1) bathroom and outdoor backyard are accessible to children in care. Applicant stated that the following areas will not be accessible to children in care, one (1) living room, dining room, kitchen, laundry room, the entire second floor and the garage will not be accessible to children in care. LPA observed safety gate located on the bottom step of the stairs making the entire 2nd floor inaccessible to children in care, LPA also observed gates blocking off the living room, dining room and kitchen. LPA reminded applicant that the gate must always be secured when children are present. CONT 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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 FAMILY CHILD CARE	FACILITY NUMBER: 426216160
	VISIT DATE: 10/12/2021

NARRATIVE

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In the kitchen, LPA observed that knives are stored in a high cabinet out of reach of children. LPA observed that medication for family is stored in a high cabinet in the kitchen. LPA observed the 2 A10 BC Fire Extinguisher which was serviced on 6/14/2021. The home is equipped with a combination smoke detector and carbon monoxide detector that was tested at 10:25 AM and found to be working properly. LPA observed that the bathroom used for children is clean and orderly and has hand soap, paper towels and hand washing poster for children. LPA observed plenty of children size activities and napping equipment that is safe and appropriate for children in care. LPA observed that cleaning compounds are stored in the laundry room and are inaccessible to children in care. There are no bodies of water observed. Applicant stated that there are no guns and/or ammunition in the home. LPA reminded Applicant that Fire and Disaster drills must be completed and documented twice a year. Applicant stated that she has selected two (2) days in year that are significant to Applicant and those are the days she conducts the facility’s emergency drills.

Applicant and three (3) adult children live in the home and are all fingerprinted cleared. Applicant has met the immunization requirement per SB 792 and Mandated Reporter Training for Child Care Providers (AB1207) which expires 7/23/2023. Pediatric CPR/first aid is current (expires 7/29/2022).

Incidental Medical Services (IMS) policy was discussed and Applicant confirmed that she does not administer medication at the moment but will be submitting an IMS plan to the department. 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 Safe Sleep regulations, provided copy of LIC 9227 and safe sleep regulations in Spanish. Applicant was reminded that 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.

Fire Safety Inspection clearance was granted on 10/04/2021 by Santa Maria Fire Department.

CONT 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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 FAMILY CHILD CARE	FACILITY NUMBER: 426216160
	VISIT DATE: 10/12/2021

NARRATIVE

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Exit interview was conducted by LPA with Applicant, MaryPaz Perez.

The home meets Title 22 Division 12 requirements for a large Family child Care home license. Effective date of license is today 10/12/2021

Today’s inspection and review of report was conducted in Spanish as it is Applicant’s primary language.

A Notice of Site Visit was provided to Applicant 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: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

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