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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207119
Report Date: 10/23/2019
Date Signed: 10/23/2019 03:22:09 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:FERNANDEZ FCC AKA CAROUSEL FCCFACILITY NUMBER:
566207119
ADMINISTRATOR:MARIA FERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 815-4528
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY:14CENSUS: 7DATE:
10/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Maria FernandezTIME COMPLETED:
03:30 PM
NARRATIVE
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An annual random was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and B. Cervantes who met with Licensee Maria Fernandez and her assistant. The home was toured inside and outside. Licensee stated there are no firearms, ammunition or bodies of water on the premises. LPAs did not observe any bodies of water. The fire place was observed to be screened. There is a 2 A10BC Fire Extinguisher was serviced on 03/20/2019. 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. The last fire drill was conducted on 10/19/2019. The children’s records were reviewed for emergency information. LPAs reviewed “Safe Sleep in Child Care, Safe Sleep for your Baby, and Effects of Lead Exposure” and provided handouts. Licensee Maria Fernandez has current CPR and First Aid which expires on 12/13/2019. LPAs discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. Verification reviewed for Licensee and her assistant. LPAs reviewed verification of AB 1207 Child Abuse Mandated Reporter Training for licensee.

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
No deficiencies were cited. The Notice of Site Visit was posted at the visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
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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