426216217-3-22-2022-17-CC-FVEZ-CCRVCL-20220322161919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216217
Report Date: 03/22/2022
Date Signed: 03/22/2022 04:19:45 PM

Document Has Been Signed on 03/22/2022 04:19 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	VAZQUEZ FCC AKA BIG BROTHER DAY CARE		FACILITY NUMBER:	426216217
ADMINISTRATOR:	ROBERTO DE JESUS VAZQUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 863-8218
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	03/22/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	01:48 PM
MET WITH:	Roberto de Jesus Vazquez		TIME COMPLETED:	02:15 PM

NARRATIVE

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On March 22, 2022 at 1:48 PM, Licensing Program Manager (LPM) Maria Mueller and Licensing Program Analyst (LPA) Francisca Velazquez met with the Applicant, Roberto de Jesus Vazquez for an Informal Conference held via Zoom. The purpose of the conference was to discuss the control of property that was submitted with the application. During Application review, it was noted that the owners of this property are Roberto de Jesus Vazquez and Kiana Nicole Tell. It is also noted that Kiana Nicole Tell is a Licensee at facility number 426215738 located at 305 South Scott Drive Santa Maria, CA 93454.

The following was discussed with Applicant:

102417 Operation of a Family Child Care Home

(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

102352 Definitions

(h) (1) "Home" means the licensee's residence as defined by Government Code Section 244.

Government Code Section 224 states:

In determining the place of residence the following rules shall be observed:

(a) It is the place where one remains when not called elsewhere for labor or other special or temporary purpose, and to which he or she returns in seasons of repose.
CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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: VAZQUEZ FCC AKA BIG BROTHER DAY CARE	FACILITY NUMBER: 426216217
	VISIT DATE: 03/22/2022

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102416.2 Reporting Requirements:

(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).

(2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

LPM informed Applicant that all unusual incident reports can be emailed to unusualincidentreportsDO17@dss.ca.gov

102402 Revocation or Suspension of a License or Registration

(a) The Department shall have the authority to suspend or revoke any license for the following reasons:

(1) Violation by the licensee of any of the laws, rules and regulations governing family child care homes.

(2) Aiding, abetting, or permitting the violation of any of the laws, rules and regulations governing family child care homes.

(3) Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.

(4) The conviction of a licensee, or other person specified in Section 102369(b)(8), at any time during licensure, of a crime as defined in Sections 102370(b) and (c).

(5) Failure to comply with the requirements for training in preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, as specified in Health and Safety Code Section 1596.866.

Applicant understand that upon being licensed this facility will be placed on two (2) year required visits.

CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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: VAZQUEZ FCC AKA BIG BROTHER DAY CARE	FACILITY NUMBER: 426216217
	VISIT DATE: 03/22/2022

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Applicant stated that Kiana Nicole Tell co-signed for the property so that Applicant can purchase the property. Applicant submitted LIC 9149 that Kiana Nicole Tell signed on 11/17/21. Applicant stated that Kiana Nicole Tell does not live in the home. Per Applicant, Roberto is the only adult living in the home. LPM and Applicant reviewed all adults fingerprinted and associated in the home and Applicant stated that all the adults will be working in the home and not living in the home.

Exit interview was conducted and review of report was reviewed with Applicant, Roberto de Jesus Vazquez. Applicant understands that this report will be emailed to Applicant. Applicant agrees to sign the report and email back to LPA Velazquez at francisca.velazquez@dss.ca.gov

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC809 (FAS) - (06/04)

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