566207119-9-28-2021-17-CC-ARIS-C7ATPT-20210928145453

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566207119
Report Date: 09/28/2021
Date Signed: 09/28/2021 02:55:03 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 FCC		FACILITY NUMBER:	566207119
ADMINISTRATOR:	MARIA FERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 815-4528
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY:	14	CENSUS: 6	DATE:	09/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Maria Fernandez		TIME COMPLETED:	03:02 PM

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On September 28, 2021 at 1:50 PM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced annual inspection. LPA met with licensee Maria Fernandez and discussed the nature and purpose of the inspection. Together both licensee and LPA conducted a tour of the home inside and outside. There was six children in care at the time of the inspection.

The licensee uses the family room, dining room, living room, one restroom, and backyard for the day-care. LPA observed a gate at the bottom of the stairs preventing children from having access to the upstairs. There are no bodies of water in the home. Licensee states that there are no firearms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. In the living room, LPA observed a fireplace with a shelf in front of it preventing children from having access. There are age appropriate toys and furniture readily accessible to children throughout the house. The backyard is fully enclosed with a fenced wall. Licensee has age appropriate toys and play structures in the backyard in good condition and free of hazards. LPA observed there was ample amount of shade available for children.

The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the kitchen with a service date of 3/23/2021. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 11/2021. Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring in 12/2021. The last fire drill was conducted in 7/2021. All required forms are prominently posted for parent's or authorized representatives to view at the entrance of the facility.

Continued on 809-C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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: FERNANDEZ FCC AKA CAROUSEL FCC	FACILITY NUMBER: 566207119
	VISIT DATE: 09/28/2021

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A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete.

LPAs spoke with licensee regarding safe sleep regulations and observed current safe sleep requirements are being met and was readily available for LPA to review. Each infant had their own crib and LIC9227 Individual Infant Sleeping Plan form was in the children's file as well as a fifteen minute documentation check was posted.

Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

LIC809 (FAS) - (06/04)

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