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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566201078
Report Date: 07/12/2023
Date Signed: 07/12/2023 02:00:06 PM


Document Has Been Signed on 07/12/2023 02:00 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:WAGNER FAMILY CHILD CAREFACILITY NUMBER:
566201078
ADMINISTRATOR:WAGNER, J. 98FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 405-3922
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:14CENSUS: 4DATE:
07/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:JOANN WAGNERTIME COMPLETED:
02:15 PM
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On July 12, 2023, Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced required-1 Year inspection. LPA met with licensee Joann Wagner and advised the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There were four school-age children in care at the time of the inspection along with licensee's husband.

LPA observed required licensing documents mounted on the wall. Fire and earthquake drills are being documented every six months. Last drill was conducted on 5/3/23. A regulatory fire extinguisher was observed to be mounted on the wall with a service date of 8/12/22. Fire and carbon monoxide detectors were tested by the licensee at 1:12 PM and found to be working.

Children in care have access to two bedrooms, one restroom, kitchen, living room, den and back yard. Fire place inside the living room is screened to prevent access by children. Children have access to toys that are age-appropriate inside and outside of the home. Back yard play area is enclosed. Licensee has a jacuzzi with a hardcover in the backyard. LPA reminded Licensee to ensure inaccessibility of pools/jacuzzi's (in-ground and above-ground). LPA also provided a copy of section 102417 Operation of a Family Child Care Home and highlighted section 102417(5)(A) and 102417(5)(B). During the tour, LPA did not observe any hazards/toxins items accessible to children in care.

LPA reviewed four out of four children files. All children files were current. Licensee CPR/first aid is valid through 5/2025. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com

Continued on 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
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: 07/12/2023
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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 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 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. Licensee states she cares for an infant, but is currently not in the home. LPA observed a safe sleep log being documented for the infant in care every 15 minutes.

Licensee advised there were no children in care that required Incidental Medical Services. 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

There were no deficiencies cited during todays inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee Joann Wagner.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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