426216168-10-12-2021-17-CC-FVEZ-C7QUXT-20211012155853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 10/12/2021
Date Signed: 10/12/2021 03:59:05 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:	CORREA FCC AKA ALYSSA'S CHILD CARE		FACILITY NUMBER:	426216168
ADMINISTRATOR:	ALYSSA CORREA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 966-1964
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	14	CENSUS: 0	DATE:	10/12/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Alyssa Correa		TIME COMPLETED:	04:20 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 1:15 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced pre-licensing inspection of the facility. Prior to entering the facility, LPA conducted a 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, Alyssa Correa and Assistant Jessica Garcia and explain the purpose of the Inspection. During this inspection, there were no children present at the facility. LPA conducted the physical plant tour of the home. During this tour the following was noted: Applicant applied for a Large Family Child Care on 08/02/2021. Family members residing in the home are three (3) adults. All adults in the home are fingerprint cleared. Per Applicant, the operating days and hours of the day care will be Monday through Sunday for 24 hours. Applicant states she wants to care for children from birth to 13 years of age. Fire inspection was granted on 08/09/2021 by the Santa Maria Fire Department. All areas identified on the facility sketch were inspected. This is a two (2) story home which consists of four (4) bedrooms, three (3) bathrooms, two (2) living rooms, kitchen, dining room garage and fenced backyard. 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 designated day care areas to be safe with age appropriate toys, games etc. The back yard is enclosed with wooden fence. There are no bodies of water observed. Off limit areas include: one (1) living four (4) bedrooms, two (2) bathrooms, kitchen, dining room and garage and part of the back yard. Kitchen is made inaccessible by a child safety gate. Bedrooms and garage door has plastic safety cover knobs. LPA observed a small baby gate located in the bottom step of the stairs, making the whole 2nd for inaccessible to children in care. 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: CORREA FCC AKA ALYSSA'S CHILD CARE	FACILITY NUMBER: 426216168
	VISIT DATE: 10/12/2021

NARRATIVE

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Areas used by children included: one (1) living room, one (1) bathroom and part of enclosed back yard. LPA observed a wooden fence dividing the back yard as only part of the backyard will be accessible to children in care. There are age appropriate toys and napping equipment on the premises. Knives are stored out children’s reach in a high cabinet in the kitchen that is inaccessible to children. The required fire extinguisher 2A10BC was purchased in 08/25/2021. LPA reminded Applicant that fire extinguisher needs to be purchased or serviced annually.LPA observed a combination smoke and carbon monoxide detector in the daycare area that was tested 1:46 PM and was functioning at the time of the visit. Applicant stated that parents will be entering the facility through the side door and COVID-19 pre-screenings will be conducted by the sliding door that leads straight into the day care area of the home. Per Applicant, there are no guns nor ammunition in the home. First Aid and emergency kits are available. The Applicant completed the Orientation on 01/09/2021. The Applicant has current Pediatric First Aid and CPR which expires 01/18/2022. Applicant completed Preventative Health Training 01/15/2021. Applicant completed the Mandated Reporter Training on 01/16/2021. Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles. Applicant has submitted proof of having at least one (1) year experience working in a child care setting.

The following was discussed with the applicant:
· Individuals who are 18 years of age or older living in the home or working in the home, must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain the 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, immunization's, and a valid criminal record clearance associated to the facility license.
· A current roster of children enrolled must be available for review and maintained for a period of three years, even after children are no longer 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 in the home should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if applicant moved to another location/ home.

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: CORREA FCC AKA ALYSSA'S CHILD CARE	FACILITY NUMBER: 426216168
	VISIT DATE: 10/12/2021

NARRATIVE

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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.
· 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.

Incidental Medical Services (IMS) policy was discussed. Applicant stated facility will not administer medication. 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

No prohibited equipment will be allowed or used in the home. 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 Department inspection rights authority.

LPA, Applicant and Assistant reviewed Safe Sleep Regulations. LPA provided a copy of PIN 20-24 and LIC 9227 and reviewed regulations with Applicant and Assistant.

LPA also advised against sleeping infants in a separate room.

During this visit, LPA assisted Applicant and Assistant in registering their emails to receive Provider Information Notices (PINs). LPA reviewed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) with the Applicant and Assistant. LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov
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)

Page: 3 of 4

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: CORREA FCC AKA ALYSSA'S CHILD CARE	FACILITY NUMBER: 426216168
	VISIT DATE: 10/12/2021

NARRATIVE

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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

Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPA reviewed and provided copy of Guidance for Child Care Providers and Programs updated on 06/29/2021. LPA reviewed and discussed over-night care regulations with Applicant and provided a copy of CCR 102426 for Applicant to review.

Exit interview was conducted with Applicant, Alyssa Correa. Notice of site visit was printed and posted by Applicant prior to LPA leaving the facility. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

Pre-licensing inspection and review of this report was conducted in Spanish as Applicant feels more comfortable communicating in Spanish.

The home meets Title 22 Division 12 California Code of Regulations requirements of a Large Family Child Care Home (FCCH). Effective date of license is 10/12/2021.

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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