426216264-3-17-2022-17-CC-FPEA-CCLQ4R-20220317115046

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216264
Report Date: 03/17/2022
Date Signed: 03/17/2022 11:50:53 AM

Document Has Been Signed on 03/17/2022 11:50 AM - 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:	FONSECA FAMILY CHILD CARE		FACILITY NUMBER:	426216264
ADMINISTRATOR:	YADIRA FONSECA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 757-1067
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 3	DATE:	03/17/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:04 AM
MET WITH:	Yadira Fonseca		TIME COMPLETED:	12:05 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	This is a change of location, previous facility number 426215918 . On March 17, 2022 at 10:00 AM, Licensing Program Analysts (LPAs) Francisco Pedroza and Rosie Breault conducted an announced Pre-licensing change of location inspection. LPAs met with licensee Yadira Fonseca. Licensee provided LPAs a tour of the home inside and out. Licensee had her three (3) children in care at the time of the inspection. Licensee has a two (2) story home. Care will only be provided on the first floor. Licensee will be using the living room, kitchen, garage (for play and activities only), backyard, and one restroom. The second story will be off limits. LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher was purchased on 2/27/2022 and observed mounted on the wall in the kitchen. Licensee is reminded to service or purchase the fire extinguisher yearly. LPAs observed a combined smoke and carbon monoxide detector. The detector was not tested because the licensee's infant was sleeping at the time of the inspection. There are age appropriate toys and day-care equipment in the home. The backyard is enclosed with a cement wall. The back yard has age appropriate toys and day-care equipment. LPAs advised Licensee must provide visual supervision while the children are playing outside in the backyard. Licensee advised the facility does not have firearms or live ammunition in the home. Licensee's First Aid/CPR certificates is valid until 1/1/2024. Licensee advised that she does have liability insurance. Licensee provided a mortgage document to verify control of property. Licensee was informed walkers, bouncers and any similar object that restricts children's movement is prohibited from licensed facilities. Licensee was informed that she will be scheduled fora conference at a later date to discuss concerns Community Care Licensing may have. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

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: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 426216264
	VISIT DATE: 03/17/2022

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LPA reviewed, discussed and gave applicant updated samples of state required forms to be kept in the children's file, required forms to be posted and forms that needs to be maintained at the FCCH.
LPAs discussed current Covid-19 guidelines and provided licensee a self-assessment. Licensee was provided a Carbon Monoxide resource. Licensee was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC809 (FAS) - (06/04)

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