<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207168
Report Date: 10/05/2021
Date Signed: 10/05/2021 10:43:43 AM

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 LUPITA'S FAMILY CHILD CAREFACILITY NUMBER:
566207168
ADMINISTRATOR:LEONOR FERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 983-2063
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY:14CENSUS: 6DATE:
10/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Guadalupe FernandezTIME COMPLETED:
10:50 AM
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
On October 5, 2021 at 9:27 AM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced annual inspection. LPA met with licensee Guadalupe 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 play room, one restroom, and backyard for the day-care. LPA observed a gate in front of the stairs preventing children from having access. 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.There are age appropriate toys and furniture readily accessible to children. The backyard is fully enclosed with a concrete 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 play room with a service date of 2/18/2021. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 9/2023. Licensee and assistant have AB 1207 Mandated Reporter Training Certificate on file expiring on 6/27/2023. The last fire drill was conducted on 9/7//2021. All required forms are prominently posted for parent's or authorized representatives in the at the entrance of the play room.

Continued on 809-C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
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 2
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 LUPITA'S FAMILY CHILD CARE
FACILITY NUMBER: 566207168
VISIT DATE: 10/05/2021
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
26
27
28
29
30
31
32
A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete.

LPA spoke with licensee regarding safe sleep regulations and observed current safe sleep requirements are being met and was readily available for LPA to review.

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 TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2