566212317-10-7-2021-17-CC-FPEA-C7KSGX-20211007135241

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566212317
Report Date: 10/07/2021
Date Signed: 10/07/2021 01:52:47 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:	FERNANDO FAMILY CHILD CARE		FACILITY NUMBER:	566212317
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	10/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Kumudu Fernando		TIME COMPLETED:	01:15 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 7, 2021 at 12:15 pm, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with Licensee Kumudu Fernando and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There was one (1) child in care at the time of the inspection. Licensee has required state forms posted on a board located in the living room. Licensee use the dayroom, living room, kitchen, one (1) restroom, and back yard for children in care. LPA did not observe any toxin/hazards accessible to children in care. LPA observed disinfectant sprays up on shelves not accessible to children in care. Licensee has cleaning chemicals secured in the garage inaccessible to children in care. LPA observed a 2A10BC fire extinguisher with a purchase date of 6/13/21 mounted in the kitchen on the wall readily accessible. LPA observed a fireplace in the living room with a screen and other materials blocking the opening preventing children from having access. The facility has working smoke and carbon monoxide detectors. LPA observed age appropriate toys and furniture readily accessible to children in care. Facility provides pack and plays for infants are sleeping mats for larger children when they want to sleep. Licensee advised that the facility does not have any children enrolled that require incidental medical services (IMS). Licensee advised the facility does not have any firearms or live ammunition in the home. The backyard is enclosed by a wood fence. Half of the backyard is blocked off with a fence preventing children from accessing the garden area and storage containers. LPA observed the container was properly secured with a lock. LPA observed age appropriate toys and structures in the backyard readily accessible to children in care. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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: FERNANDO FAMILY CHILD CARE	FACILITY NUMBER: 566212317
	VISIT DATE: 10/07/2021

NARRATIVE

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LPA observed the facility roster identified that it was current. A sampling of children records were reviewed and found to be current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Licensee's Pediatric CPR/First-Aid certificate is current and valid until 6/12/2023. Licensee's Mandated Reporter certificate is current and valid until 4/28/2022. The last fire drill was completed on 4/12/2021. Licensee reminded to ensure the fire/emergency drills are logged and completed once every six (6) months. LPA discussed current Safe Sleep and Covid-19 requirements with licensee.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

No deficiencies were cited during today's inspection.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC809 (FAS) - (06/04)

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