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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566206919
Report Date: 11/07/2019
Date Signed: 11/07/2019 03:18:55 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:ALARCON FCC AKA GUARDIAN ANGEL DAY CAREFACILITY NUMBER:
566206919
ADMINISTRATOR:JACQUELINE ALARCONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 512-2939
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:14CENSUS: 9DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jaqueline AlarconTIME COMPLETED:
03:25 PM
NARRATIVE
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An annual random was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and J. Laxo who met with Licensee Jaqueline Alarcon, and her assistant. The home was toured inside and outside. The home was observed to be clean and orderly. Licensee stated there are no firearms, ammunition or bodies of water on the premises. LPAs did not observe any bodies of water. LPAs observed personal hygiene items that indicate "Keep Out of Reach of Children" in the restroom cabinet, hallway cabinet and in the master bedroom which are stored at approximately 4 feet 3 inches. The 2 A10BC Fire Extinguisher was serviced on 10/31/2019. LPA advised the licensee the Fire Extinguisher needs to be serviced or replaced yearly. There is a dual smoke/carbon monoxide detector in the home which was tested. The children’s records were reviewed for emergency contact information. LPAs reviewed “A Child Care Provider’s Guide to Safe to Sleep, Safe Sleep, and Effects of Lead Exposure” handout with Licensee. Licensee's CPR and First Aid is current (expires 02/2020).

LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPAs reviewed verification of immunization at the visit for licensee/and assistant. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
Licensee and her assistant have completed AB 1207 Child Mandated Reporter Training.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: ALARCON FCC AKA GUARDIAN ANGEL DAY CARE
FACILITY NUMBER: 566206919
VISIT DATE: 11/07/2019
NARRATIVE
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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

The following Type B deficiency is cited according to CCR, Title 22, Division 12, on 809d in regards to personal hygiene which indicate "Keep out of Reach of Children" stored approximately 4 feet 3 inches in the home. Appeal Rights were provided.

An exit interview was conducted with Licensee and a plan of correction was developed.

The Notice of Site Visit was posted at the visit.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ALARCON FCC AKA GUARDIAN ANGEL DAY CARE
FACILITY NUMBER: 566206919
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2019
Section Cited

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Operation of a FCCH: The home shall be free from defects... which might endanger a child.Safety precautons shall include but not be limited to... detergents, cleaning compounds, medicines...and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
The above regulation was not met as evidenced by:
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Based on observation the Licensee failed to ensure personal hygiene items that indicate "Keep Out of Reach of Children" in the restroom cabinet, hallway cabinet and in the master bedroom which are stored approximately 4 feet 3 inches are inaccessible to children, which Poses a potential Health, Safety or Personal Rights risk to children in care
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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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3