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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566204139
Report Date: 05/09/2023
Date Signed: 05/09/2023 03:16:14 PM


Document Has Been Signed on 05/09/2023 03:16 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:ALVAREZ FAMILY CHILD CAREFACILITY NUMBER:
566204139
ADMINISTRATOR:ALVAREZ, ALVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 797-4192
CITY:OXNARDSTATE: CAZIP CODE:
93035
CAPACITY:14CENSUS: 1DATE:
05/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Alva AlvarezTIME COMPLETED:
03:30 PM
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On May 9, 2023 at 1:30 PM, Licensing Program Analyst Susana Martinez conducted an unannounced Annual/Random inspection. LPA met with licensee Alva Alvarez and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There was one child in care and no other adults at the time of inspection.

Licensee states she has not cared for children since COVID until today. Last drill was conducted on 12/21/2021. Licensee was reminded fire and earthquake drills should be conducted and documented every six months. A fire extinguisher 2A10BC was observed to be located under the kitchen sink with a service date of 9/15/20. Licensee was reminded to purchase or service a regulatory fire extinguisher yearly. Dual smoke and carbon monoxide detector mounted on the wall was tested by the Licensee and found to be working.

Children in care have access to two rooms, one restroom, kitchen, living room, and back yard. Fire place inside the living room is screened to prevent access by children. Kitchen knives are being kept in a cabinet above counters to keep out of reach from children. Children have access to toys that are age-appropriate inside and outside of the home. Back yard play area is enclosed and has plenty of play structures. Licensee denies having any guns or ammunition in the home. There were no bodies of water present at the time of inspection. During the tour, LPA did not observe any hazards/toxins items accessible to children in care.

LPA reviewed one out of one children files. Child's file was found to be complete and current. Licensee's CPR/first aid certification conducted 5/24/22, which was completely done online. 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. LPA observed Licensee last conducted the Mandated Reporter Certification in 2018. LPA provided Mandated Reporter Training Information.

Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023
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: ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 566204139
VISIT DATE: 05/09/2023
NARRATIVE
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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. LPA provided a copy of an Individual Infant Sleeping Plan (LIC9227) and a sleep log template. LPA will email Licensee Safe Sleep FAQ's along with PIN 20-24-CCP regarding Safe Sleep.

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

Two Type B deficiencies were issued during today's inspection and are attached on the 809-D. One Technical Assistance for missing Parent's Rights and one Technical Violation for missing mandated reporter certification was issued during today's 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 Alva Alvarez.

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

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/09/2023 03:16 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: ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 566204139

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2023
Plan of Correction
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Licensee is to provide LPA Martinez with proof of service or purchase of a regulatory fire extinguisher.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/16/2023
Plan of Correction
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Licensee has enrolled to a weekend CPR/First Aid class. Licensee is to submit proof of CPR/First Aid certification to LPA Martinez by 05/16/2023.
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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3