566211061-10-12-2021-17-CC-ARIS-C7QUTT-20211012155228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566211061
Report Date: 10/12/2021
Date Signed: 10/12/2021 03:52:40 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:	MORA FAMILY CHILD CARE		FACILITY NUMBER:	566211061
ADMINISTRATOR:	DOLORES MORA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 212-6315
CITY:	PORT HUENEME	STATE: CA	ZIP CODE:	93041
CAPACITY:	14	CENSUS: 2	DATE:	10/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:16 PM
MET WITH:	Dolores Mora		TIME COMPLETED:	04:02 PM

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On October 12, 2021 at 2:16 PM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced annual inspection. LPA conducted Covid-19 screening questions prior to entering the home. LPA met with licensee Dolores Mora 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 two children in care at the time of the inspection.

The home is a single story residence and licensee uses the play room, one restroom, and backyard for the day-care. LPA observed doors locked making it inaccessible to children in care. LPA also observed a gate in front of the kitchen 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. In the play room, 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.

During the visit, LPA found that Licensee son Damien Mora lives on the premises and has not obtained a criminal record clearance with the Department since turning eighteen. Licensee was advised an immediate civil penalty assessed $500.00.

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: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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: MORA FAMILY CHILD CARE	FACILITY NUMBER: 566211061
	VISIT DATE: 10/12/2021

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The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the play room with a purchase date of 10/12/2021. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 8/9/2023. Mandated Reporter training on file.

All required forms are prominently posted for parent's or authorized representatives to view in the play room. A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete. LPA observed Identification and Emergency Notification forms (LIC 700).

LPA spoke with licensee regarding safe sleep regulations and provided licensee with safe sleep information. Licensee does not currently have any infants enrolled.

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

Pursuant to Title 22 of the CA Code of Regulations, the following Type A deficiency was cited on 809D page. Licensee shall post these reports for 30 days and provide copies of these licensing reports to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The Licensee has been provided a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports. Appeal Rights Reviewed.

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: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MORA FAMILY CHILD CARE	FACILITY NUMBER: 566211061
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/12/2021 Section Cited	1 2 3 4 5 6 7	102370(d)(1) Criminal Record Clearance: All subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed home: (1) Obtain a California clearance or a criminal record exemption...This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on interview with licensee Dolores Mora revealed her son Damien Mora turned eighteen, is living in the home, and does not have a criminal record clearance with the Department which poses an immediate risk to the health and safety of chidlren in care.	8 9 10 11 12 13 14
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

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