566212033-10-13-2021-17-CC-LVIA-C7RU8Z-20211013152223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566212033
Report Date: 10/13/2021
Date Signed: 10/13/2021 03:22:29 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:	VINA FAMILY CHILD CARE		FACILITY NUMBER:	566212033
ADMINISTRATOR:	ANNA VINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 921-1781
CITY:	SANTA PAULA	STATE: CA	ZIP CODE:	93060
CAPACITY:	14	CENSUS: 7	DATE:	10/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Anna & Mario Vina		TIME COMPLETED:	03:30 PM

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 October 13, 2021 at 2:40 PM Licensing Program Analyst (LPA), Laura Villanueva conducted an unannounced inspection to conduct an annual required visit. Prior to inspection, LPA Villanueva asked pre screening questions related to COVID 19, Licensee's response indicates there are no COVID 19 exposures on site. LPA toured the home with Licensee. There were 7 children present with Licensees. The home is a 2 story 5 bedrooms and 4.5 bath home. The Licensee uses the living room, one bathroom, and the side yard. The program is mostly outdoors. There are properly stored guns in the home. The fireplace in the living room is screened off making it inaccessible to the children. No toxins or hazards are accessible to the children in care. The fire extinguisher was serviced on 12/18/20. A fire drill was conducted on 6/10/21 . Licensees Pediatric CPR/First Aid certificate expires 8/24/22. Child files were found to be complete. Child roster is up to date. There are smoke and carbon monoxide detectors in the home. The facility is not currently providing Incidental Medical Services. Incidental Medial Services (IMS). The center provides IMS but currently does not have any children with medication. For additional IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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. Continued on LIC809C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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: VINA FAMILY CHILD CARE	FACILITY NUMBER: 566212033
	VISIT DATE: 10/13/2021

NARRATIVE

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LPA provided Licensee with safe sleep regulations, LIC 9227, and tracking form for 15 minute checks.

An exit interview was conducted and a copy of this report was given to Licensee. A technical violation was issued today.

THE NOTICE OF SITE VISIT WILL BE 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: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC809 (FAS) - (06/04)

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