566200412-10-12-2021-17-CC-ARIS-C7QPX7-20211012114152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566200412
Report Date: 10/12/2021
Date Signed: 10/12/2021 11:42:03 AM

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:	CARLSON FCC AKA OPEN ARMS DAY CARE		FACILITY NUMBER:	566200412
ADMINISTRATOR:	LINDA CARLSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 889-2633
CITY:	PORT HUENEME	STATE: CA	ZIP CODE:	93041
CAPACITY:	14	CENSUS: 1	DATE:	10/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Linda Carlson		TIME COMPLETED:	11:48 AM

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On October 12, 2021 at 10:00 AM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced annual inspection. LPA conducted Covid-19 screening questions prior to entering the home. LPA met with licensee Linda Carlson and discussed the nature and purpose of the inspection. Together both licensee and LPA conducted a tour of the home inside and outside. There was one child in care at the time of the inspection. The rest of the children enrolled were in school.

The home is a single story residence and licensee uses the family room, kitchen, day care room, one restroom, and backyard for the day-care. LPA observed all other bedroom doors were locked making it inaccessible to children in care. There are no bodies of water in the home. Licensee states that there are no firearms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care.There are age appropriate toys and furniture readily accessible to children. The backyard is fully enclosed with a concrete wall. Licensee has age appropriate toys in the backyard in good condition and free of hazards. LPA observed there was ample amount of shade available for children.

The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the kitchen with a service date of 1-2-2021. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 3/27/2023 Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 6/9/2023.

Continued on 809-C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
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: CARLSON FCC AKA OPEN ARMS DAY CARE	FACILITY NUMBER: 566200412
	VISIT DATE: 10/12/2021

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All required forms are prominently posted for parent's or authorized representatives to view in the kitchen. A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete. LPA observed Identification and Emergency Notification forms (LIC 700).

LPA spoke with licensee regarding safe sleep regulations and observed current safe sleep requirements were being met for infant in care. Licensee does not have any infants enrolled as of September.

Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 deficiencies were cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
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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