566211900-1-2-2025-17-CC-SLOS-DCJQCC-20250102110255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566211900
Report Date: 01/02/2025
Date Signed: 01/02/2025 11:03:11 AM

Document Has Been Signed on 01/02/2025 11:03 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	NATIVIDAD FCC AKA LIL' DRAGONS DAYCARE		FACILITY NUMBER:	566211900
ADMINISTRATOR/ DIRECTOR:	EVANGELINA NATIVIDAD		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 300-4298
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	01/02/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Evangelina Natividad		TIME VISIT/ INSPECTION COMPLETED:	11:15 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 1/2/25 at 9:40 AM, Licensing Program Analyst (LPA) Shane Loftus made an unannounced Required 3 Year Inspection of the Family Child Care Home (FCCH). LPA met with Licensee, Evangelina Natividad, and explained the purpose of the inspection. LPA, in the company of Licensee, toured the interior and exterior of the home. The FCCH's living room, kitchen, playroom, hallway bathroom, and backyard are used for child care, while the remaining bedrooms and garage are excluded from child care. It should be noted there were no children present during the inspection. The FCCH was observed to be clean and orderly. The FCCH has ventilation for the children in care. LPA observed required licensing forms and documents posted prominently on the wall by the front door. The FCCH does not have a fireplace. The bathroom used for child care is observed to be clean and free of toxins. Sharps are located in a kitchen cabinet, which is secured with a child safety lock and inaccessible to children. Detergents and cleaning compounds are stored in a cupboard beneath the kitchen sink and secured with a child safety lock. Medications are stored in an elevated cabinet in the kitchen and in the master bedroom, which is inaccessible to children. LPA observed a dual carbon monoxide/smoke detector in the FCCH which was tested at 9:55 AM and found to be operational. The FCCH has a regulation fire extinguisher that was purchased on 7/31/24. LPA reminded the Licensee to service or purchase a regulation fire extinguisher annually. The FCCH’s backyard is enclosed with cinderblock fencing and has varied footing surfaces. The back yard is partitioned with child safety gates to provide a play area separate from the rest of the back yard. LPA notes the toys and equipment in the back yard are age appropriate. There is a shed in the back yard that is locked and contains outdoor tables, chairs, and yard equipment. Additionally, no bodies of water are observed on site. Continued on 809-C

Maria Mueller	TELEPHONE: (805) 562-0400
Shane Loftus	TELEPHONE: (805) 562-0400
	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NATIVIDAD FCC AKA LIL' DRAGONS DAYCARE	FACILITY NUMBER: 566211900
	VISIT DATE: 01/02/2025

NARRATIVE

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LPA reviewed the children’s records. All records reviewed are current and complete including emergency contact information and immunization records. LPA reviewed the Licensee's records which were found to be current and complete with Pediatric CPR/First Aid certifications expiring in 7/22/26 and Mandated Reporter (AB1207) training expiring on 7/19/25. Licensee was reminded to keep certifications current and renew certification prior to expirations. At 10:30 AM LPA notes the last fire drill was conducted in June of 2024. LPA reminded Licensee that emergency/fire drills need to be conducted and documented every 6 months. Licensee informed LPA no firearms or ammunition are stored on site.

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

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 for 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane Loftus	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NATIVIDAD FCC AKA LIL' DRAGONS DAYCARE	FACILITY NUMBER: 566211900
	VISIT DATE: 01/02/2025

NARRATIVE

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During the exit interview Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

A Technical Violation is being cited based on LPA’s records review and observations pursuant to Title 22 of the CA Code of Regulations. Licensee was provided a copy of their appeal rights.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Evangelina Natividad.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane Loftus	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

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