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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566209849
Report Date: 05/05/2022
Date Signed: 05/05/2022 11:02:57 AM


Document Has Been Signed on 05/05/2022 11:02 AM - It Cannot Be Edited

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:ROBLES FAMILY CHILD CAREFACILITY NUMBER:
566209849
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Lilia RoblesTIME COMPLETED:
11:15 AM
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On May 5, 2022 at 9:20AM, Licensing Program Analyst (LPA) Betzayra Cervantes made an unannounced visit to conduct a Required - 1 Year and Capacity Change inspection. LPA met with licensee, Lilia Robles and explained the purpose of the inspection. LPA conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA in the company of the licensee toured the interior and exterior of the facility. There were three children in care at the time of the inspection.

On April 28, 2022, the Oxnard Fire Department conducted a fire inspection for an increase in capacity. Fire clearance approval for the large FCCH was granted on 04/28/2022. The home is a three bedroom, two bath single story home. The Licensee uses the living room, one bedroom, dining room, kitchen, back yard, and one bathroom for day-care. The laundry room, two bedrooms, one bathroom and detached garage are off limits to children in care. LPA observed a screened fireplace in the living room, making it inaccessible. LPA observed age appropriate toys and furnishings available for children in care in good condition and free of hazards. Licensee has a secured fence in the backyard and age appropriate toys for children in care, found in good condition and free of hazards. LPA observed a secured above ground pool in the backyard. The above ground pool was secured with fence. One locked storage shed and one lock storage chest were also observed. Licensee states that there are no firearms and ammunition in the home. Licensee states that she has one dog who stays in the sideyard. Licensee reported that the dog's vaccinations are up to date.

No toxins nor hazards are accessible to children in care. Detergents and cleaning compounds are stored out of reach of children. The bathroom to be used for children in care was observed to be clean and sanitary. LPA observed a dual carbon monoxide and smoke alarm detector which was tested and found to be operable. A regulation 2A10BC fire extinguisher was observed with a service date of 1/21/22. Licensee is reminded to service or purchase the fire extinguisher yearly.

CONTINUED ON 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 566209849
VISIT DATE: 05/05/2022
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Licensee's Pediatric First Aid/CPR certificate is valid until 03/22/2023. Licensee last completed an emergency disaster drill on 04/10/2022. AB1207 Mandated Reporter Training Certificates are current with an expiration date of 07/25/2023. All required forms including Notification Of Parent's Rights are prominently posted for parent's or authorized representatives to view. A roster of children in care was observed current and complete. A sampling of children records were reviewed and LPA observed Identification and Emergency Notification forms (LIC 700) and a copy of immunization records on file.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies cited during this visit. License to operate a Large Family Child Care facility is effective today, 05/05/2022. Once licensed, the licensee is required to comply with the terms and limitations stated on the license.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed in Spanish with the licensee, Lilia Robles.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC809 (FAS) - (06/04)
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