566206538-9-24-2019-17-CC-LVIA-BGBS6S-20190924133626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566206538
Report Date: 09/24/2019
Date Signed: 09/24/2019 01:36:33 PM

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:	TELLEZ MAYA FAMILY CHILD CARE		FACILITY NUMBER:	566206538
ADMINISTRATOR:	TELLEZ, ELIA MAYA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 525-2370
CITY:	SANTA PAULA	STATE: CA	ZIP CODE:	93060
CAPACITY:	14	CENSUS: 2	DATE:	09/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:15 AM
MET WITH:	Elia Tellez		TIME COMPLETED:	01:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Laura Villanueva made an unannounced inspection in order to conduct an ANNUAL /RANDOM inspection and met with the licensee, Elia Tellez. The purpose of the visit was discussed and a tour of the one story home was conducted inside and outside. There are age appropriate toys and equipment. Licensee stated that there were no firearms in the home. Licensee uses the living room, one bedroom, bathroom, and front yard for the day-care. LPA toured these areas and found them free of hazards. Licensee stated that one bedroom was off-limits to day-care children. The home maintains a current Fire extinguisher serviced on 2/6/19. The home also maintains a working smoke and carbon monoxide detector that meet the statutory requirement. There was a current facility roster present. CPR/First for licensee was current with an expiration date of 4/22/21. Licensee conducts emergency disaster drills. Last drill was conducted on 8/16/19. Licensee is current with SB792(Mendoza). Mandated Reporter Training was completed 9/20/19. Licensee stated that there are no children on medication currently 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

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

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: TELLEZ MAYA FAMILY CHILD CARE	FACILITY NUMBER: 566206538
	VISIT DATE: 09/24/2019

NARRATIVE

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LPA provided information on Sudden Infant Death Syndrome (SIDS)Safe Sleep, Lead Poisoning flyer, and a Child Care Program Summer 2019 Quarterly Update to Licensee.

Applicant was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

In the areas that were evaluated no deficiencies were cited under Title 22 Division 12.

Notice of Site Visit will be posted.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

LIC809 (FAS) - (06/04)

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