566213065-7-21-2022-17-CC-RCHZ-CGJQ9P-20220721115841

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566213065
Report Date: 07/21/2022
Date Signed: 07/21/2022 11:58:49 AM

Document Has Been Signed on 07/21/2022 11:58 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	MAHONEY FAMILY CHILD CARE		FACILITY NUMBER:	566213065
ADMINISTRATOR:	JAMIE MAHONEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 450-6938
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	14	CENSUS:	DATE:	07/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Jamie Mahoney		TIME COMPLETED:	12:15 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 July 21, 2022 @9:19 AM Licensing Program Analyst (LPA) Rona Chavez made an unannounced annual inspection. LPA met with Licensee, Jaime Mahoney and explained the purpose of the visit. Licensee provided a tour of inside and outside of the home. There were 10 children in care at the time of the inspection. The Licensee uses the living room, dining room, kitchen, family room and bathroom for the day care. The backyard is completely fenced in with school-age appropriate equipment such as a loft as a playhouse. The storage sheds are locked and there is a fence with a locked gate keeping a locked jacuzzi separated from the children. Jacuzzi also has pad lock on cover. There are 9 chickens in a fenced area. There are 2 dogs in the garage that are not with the child care children. They have their immunization up to date. The toxins are stored in the locked garage and outdoor shed making them inaccessible to the children. The regulation fire extinguisher was purchased on 7/21/22. The smoke detector and the carbon monoxide detector were observed to be functional. LPA observed fireplace in the living room with screen making it inaccessible to children in care. Licensee states there are no firearms in the home. All required forms are prominently posted for parent's or authorized representatives to view at the entrance of the facility. A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete. Licensee has AB 1207 Mandated Reporter Training Certificate on file. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 2/4/2024. Licensee had ten (10) children in care at @9:19am. Licensee's daughter/assistant arrived at 10 AM to assist with the day care.California Code of Regulation (Title 22 Division 12 102416.5(e) type B deficiency is being cited on the attached LIC 809 D). Cont on 809-C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

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: MAHONEY FAMILY CHILD CARE	FACILITY NUMBER: 566213065
	VISIT DATE: 07/21/2022

NARRATIVE

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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

Incidental Medical Services (IMS) policy was discussed. Licensee is not providing IMS at the present time. 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

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.

Title 22 Division 12 102416(c) type B deficiency is being cited on the attached LIC 809 D).

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee, Jamie Mahoney.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3

Document Has Been Signed on 07/21/2022 11:58 AM - It Cannot Be Edited

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: MAHONEY FAMILY CHILD CARE	FACILITY NUMBER: 566213065
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. When LPA arrived licensee was home alone with 10 children, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/21/2022
	Plan of Correction
1 2 3 4	Licensee daughter/assistant arrived while LPA was still at facilty. Licensee will no longer exceed 8 children while alone.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC809 (FAS) - (06/04)

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