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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566202176
Report Date: 05/02/2023
Date Signed: 05/02/2023 03:04:37 PM


Document Has Been Signed on 05/02/2023 03:04 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:DIAZ FAMILY DAY CARE HOMEFACILITY NUMBER:
566202176
ADMINISTRATOR:DIAZ, MINERVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 795-2395
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:14CENSUS: 12DATE:
05/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Minerva DiazTIME COMPLETED:
03:30 PM
NARRATIVE
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On 05/02/2023 at 11:30 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the Family Child Care Home (FCCH). LPA met with Minerva Diaz, licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of licensee toured the interior and exterior of the FCCH. LPA notes twelve (12) children are present being cared by licensee and two (2) assistants.

This is a two-story home with five (5) bedrooms, four (4) bathrooms, living room, dining room, kitchen, garage and outdoor yard. The day-care services occur in the living room, dining area, one (1) bedroom, one (1) bathroom, and outdoor yard. Meanwhile, the entire second floor which consists of three (3) bedrooms, two (2) bathrooms and one office are off-limits. LPA notes a small baby gate is located on the first step of the stairway making the second floor inaccessible to children in care. Additionally, one (1) bedroom and garage on the first floor are inaccessible to children in care. LPA observed garage to have safety latch to ensure it is inaccessible to children in care.

LPA observed the home to be clean and orderly. There is plenty of ventilation to afford the children comfort. LPA observed sharps are stored in an elevated cabinet in the kitchen. Medication for the family is stored in a separate elevated cabinet in the kitchen. Cleaning compounds are stored in the garage, which are inaccessible to children in care. In the living room, LPA observed a fireplace that will be made inaccessible by a screen and latch. The rest-room that is used for child-care services is clean and free of toxins. In the FCCH, LPA observed toys, furniture, and equipment are in good conditions and are age appropriate for the children in care.

Required forms are predominantly posted in the living room. LPA observed a smoke and carbon monoxide detectors in the FCCH that were tested at 1:00 PM and were operable during this inspection. LPA observed the home has a regulation fire extinguisher that was serviced on 08/12/2022. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 05/02/2023 03:04 PM - It Cannot Be Edited

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: DIAZ FAMILY DAY CARE HOME
FACILITY NUMBER: 566202176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that Annie Marie Lopez was providing care and supervision to children without criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2023
Plan of Correction
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Licensee agrees to ensure Annie Marie Lopez gets criminal record clearance and does not directly supervise any children until individual receives clearance. Proof of live scan request form will be submitted to Francisca.Velazquez@dss.ca.gov by 5/3/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2023
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Document Has Been Signed on 05/02/2023 03:04 PM - It Cannot Be Edited

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: DIAZ FAMILY DAY CARE HOME
FACILITY NUMBER: 566202176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the last documented emergency drill was conducted on 1/17/18 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2023
Plan of Correction
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Licensee agrees to complete emergency drill and document the drill. Licensee understands emergency drills are to be completed every six months and documented. Licensee will submit proof of completion via email to Francisca.Velazquez@dss.ca.gov by 5/9/23.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2023
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Document Has Been Signed on 05/02/2023 03:04 PM - It Cannot Be Edited

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: DIAZ FAMILY DAY CARE HOME
FACILITY NUMBER: 566202176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that Licensee's AB1207 certificate expired on 2/11/21. Additionally, both assistants did not have AB1207 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2023
Plan of Correction
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Licensee agrees to update AB1207 certificate and to ensure all individuals that provide care and supervision to children have current certificate. Licensee will submit updated AB1207 for all individuals that care and supervise children via email at Francisca.Velazquez@dss.ca.gov by 5/9/23.
Mandatedreporterca.com
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that licensee reported there are no personnel files for the assistants present during inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2023
Plan of Correction
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Licensee agrees to create personnel files and have them accessible for review during inspections. Additionally, licensee agrees to email proof of personnel files via email to Francisca.Velazquez@dss.ca.gov by 5/9/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2023
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Document Has Been Signed on 05/02/2023 03:04 PM - It Cannot Be Edited

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: DIAZ FAMILY DAY CARE HOME
FACILITY NUMBER: 566202176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the twelve children present during inspection are not documented on the facility roster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2023
Plan of Correction
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Licensee agrees to update facility roster with all currently enrolled children and submit proof via email to Francisca.Velazquez@dss.ca.gov by 5/9/23.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in licensee is not documenting 15 minute checks for all infant age children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2023
Plan of Correction
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Licensee agrees to start documenting 15 minute sleep logs for all infants and submit proof via email to Francisca.Velazquez@dss.ca.gov by 5/9/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2023
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: DIAZ FAMILY DAY CARE HOME
FACILITY NUMBER: 566202176
VISIT DATE: 05/02/2023
NARRATIVE
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LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services. Licensee informed LPA no guns or ammo are stored in the home.

LPA observed the outdoor yard to be completely fenced. LPA observed the exit doors to be secured. LPA observed day-care children only have access to part of the yard. The outdoor yard provides plenty of shading for the children in care. Filtered drinking water is provided by means of individual cups. Toys, furniture, and equipment observed in the outdoor yard are age appropriate and in good conditions. No bodies of water are observed.

LPA reviewed Licensee and children's records. The children’s records were found to contain emergency contact information and some files had immunization records. Licensee is not documenting infant 15-minute sleep logs as license was not aware documentation for all infants is required. All children present during today’s inspection are not documented in the facility roster. LPA reviewed Licensee’s Pediatric First -aid certificate that is valid until 11/13/2023 and Licensee's Mandated Reporter training certification expired on 02/11/2021. The last emergency drill was conducted and documented on 01/17/2018. Assistants’ files were not reviewed as licensee did not have personnel files for the assistants present during today’s inspection.

Based on file review, LPA found that one assistant that is providing care and supervision to children has not received criminal record clearance.

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



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 CONT 809-C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
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: DIAZ FAMILY DAY CARE HOME
FACILITY NUMBER: 566202176
VISIT DATE: 05/02/2023
NARRATIVE
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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an for 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.

Today, deficiencies are being cited under Title 22 Division 12 Appeal rights given. Civil penalty was assessed. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Minerva Diaz.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
LIC809 (FAS) - (06/04)
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