566211335-7-18-2023-17-CC-LVIA-CTUQGT-20230718121004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566211335
Report Date: 07/18/2023
Date Signed: 07/18/2023 12:10:14 PM

Document Has Been Signed on 07/18/2023 12:10 PM - 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:	SANDOVAL FAMILY CHILD CARE		FACILITY NUMBER:	566211335
ADMINISTRATOR:	JESSICA SANDOVAL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 421-8309
CITY:	FILLMORE	STATE: CA	ZIP CODE:	93015
CAPACITY:	14	CENSUS: 3	DATE:	07/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jessica Sandoval		TIME COMPLETED:	12:30 PM

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On July 18, 2023 10:00 AM, Licensing Program Analyst (LPA) Laura Villanueva made an unannounced visit to conduct a Required - 1 Year Inspection. LPA met with licensee, Jessica Sandoval and explained the purpose of the inspection. LPA and Licensee toured the interior and exterior of the home. Licensee was caring for 3 children at the time of the inspection.

The home is a 3-bedroom, 2-bath 1-story home. The licensee uses living room, dining area, kitchen, one bathroom and the backyard for childcare. The bedrooms, one bathroom, and garage are off limits and are inaccessible to children in care. LPA observed a screened fireplace in the living room making it inaccessible to children in care. Licensee has a secured fence in the backyard. All adults in the home are fingerprint cleared. LPA observed toxins/hazardous items accessible to children in hallway closet and outside on a cooler. A type B citation was issued. A regulation 2A10BC fire extinguisher was observed with a purchase date of 2/22/22. Licensee is reminded to service or purchase the fire extinguisher yearly. Licensee will purchase a new fire extinguisher by 7/19/23. A technical advisory was issued.

LPA observed the home to be orderly. No bodies of water were observed on site. The bathroom to be used for children in care was observed to be clean and sanitary.LPA observed a carbon monoxide and smoke alarm detector in the hallway and master bedroom.

Licensee's Pediatric First Aid/CPR certificate is valid until 2/22/24. AB 1207 Mandated Reporter Training certificate was valid until 9/14/2019. A technical advisory was issued.Licensee will complete Mandated Reporter Training by 8/18/23. Licensee last completed an emergency disaster drill on 10/20/22. Licensee will complete an emergency drill 7/18/23. A technical advisory 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. All children records were reviewed, and LPA observed Identification and Emergency Notification forms (LIC 700) and a copy of immunization records on file. .

CONTINUED ON 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 566211335
	VISIT DATE: 07/18/2023

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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.

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

Exit interview conducted and report was reviewed with the licensee, Jessica Sandoval.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC809 (FAS) - (06/04)

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