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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207582
Report Date: 10/25/2019
Date Signed: 10/25/2019 12:32:11 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:SANDOVAL FAMILY CHILD CAREFACILITY NUMBER:
566207582
ADMINISTRATOR:ESTHER SANDOVALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 641-2352
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:14CENSUS: 7DATE:
10/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Esther SandovalTIME COMPLETED:
12:45 PM
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On 10/25/2019, at 11:35 a.m. Licensing Program Analyst, (LPA) Jill Laxo conducted an unannounced annual inspection at Sandoval Family Child Care and met with Esther Sandoval. The purpose of the inspection was discussed with the Licensee and together we toured the home inside and out. During today's visit the Licensee had seven children and one assistant.

The facility is a two story home, the day care uses the first floor, backyard and detached garage. The second floor is off limits and the stairs are gated. Detergents, cleaning products, medication and other items which could pose a danger are stored and inaccessible to children. First Aid and supplies are labeled and located in the play room hallway. There are no bodies of water on the property. Licensee states there are no firearms, weapons or ammunition in the home. Fire extinguisher is a 2A10BC was last serviced 01/08/2019. The emergency drill was last performed on 10/03/2019. The home has working smoke and carbon monoxide detectors. Licensee has all required forms posted for parents to view. Safe toys and play equipment are provided. The children have safe and comfortable accommodations. Fireplace is screened and locked. Licensee has current roster of children. Children files were reviewed and have required forms. Licensee and assistant have current CPR/First Aid with expiration date of 03/2021. Assistants proof of SB 792 Adult Immunization's verified. Licensee has coverted the detached garage, which is located in the backyard, into a playroom for extra space.
Continued on 809C
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
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 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: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 566207582
VISIT DATE: 10/25/2019
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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

A Guide to Safe Sleep and Effects of Lead Exposure brochures were provided.



No deficiencies were cited during today's visit.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2