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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566201078
Report Date: 08/09/2019
Date Signed: 08/09/2019 10:29:10 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:WAGNER FAMILY CHILD CAREFACILITY NUMBER:
566201078
ADMINISTRATOR:WAGNER, J. 98FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 581-5516
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:14CENSUS: 8DATE:
08/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Joann WagnerTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Francisco Pedroza made an unannounced inspection to conduct an Annual/Random inspection. LPA met with licensee Joann Wagner and advised her the purpose of the visit. LPA and licensee together toured the home inside and out. Licensee has a four bedroom home. There was eight children in care at the time of the visit.

The licensee uses the kitchen, two bedrooms, one restroom, sun room, and back yard for the day care. Licensee states that there are no fire arms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. LPA observed a fireplace with a metal screen in the family room preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The home has working smoke and carbon monoxide detectors. A 2A10BC fire extinguisher was observed mounted on the wall with a last service date of 08/24/2018. The backyard is fully enclosed with concrete wall. Licensee has a secured fence in the backyard preventing children from accessing an area where tools and a parked motor home is stored. Licensee has age appropriate toys and play structures in the backyard readily accessible to children. Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
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: WAGNER FAMILY CHILD CARE
FACILITY NUMBER: 566201078
VISIT DATE: 08/09/2019
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A roster of children in care was observed current and complete. A sampling of children records was reviewed and found current. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Licensee does have liability insurance for their facility. First-Aid and CPR is current until 05/06/2021. Mandated Reporter training has not been completed. The last Fire/Emergency drill was completed on 05/23/2019. LPA discussed Incidental Medical Services (IMS) with licensee. Licensee currently does not have children in care that require IMS. LPA discussed and provided licensee Safe Sleep pamphlet.

Incidental Medical Services (IMS) policy was discussed. 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 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: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019
LIC809 (FAS) - (06/04)
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