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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213327
Report Date: 06/14/2022
Date Signed: 07/13/2022 04:30:20 PM


Document Has Been Signed on 07/13/2022 04:30 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/11/2022 03:27 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

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THIS IS AN AMENDMENT OF REPORT ISSUED ON 6/14/2022

On 6/14/22 at 10:00 am Licensing Program analyst (LPA) Michael Mathew conducted an unannounced annual visit LPA met with Licensee Ana Delmar and discussed the purpose of the Visit. Prior to entering the home LPA conducted Covid-19 screening questions. Licensee and LPA toured inside and out of the home. At the time of the visit there were 10 children and 2 adults. There are age appropriate toys and equipment for children in care.

Licensee uses the, play room, hallway bathroom, and backyard for the day-care. Licensee stated that there are no guns/weapons or ammunition in the home. LPA observed the knifes are kept in the garage which is off limits to children in care. LPA observed chemicals and toxins are also kept in the garage which is off limits to children in care. Backyard is fully fenced in and have ample amount of toys and equipment for children in care. LPA observed no bodies of water during inspection. LPA observed a 2A10BC fire extinguisher present and serviced on 6/9/22. Fire alarm and carbon monoxide detector are good and in working condition. Licensees CPR/first aid is current and is valid until 5/22/23. Licensee and assistants present did not have a current mandated reporter training. Last training for licensee was completed on 4/10/2019. Fire drill was conducted on 3/4/22. LPA observed S1 who was fingerprinted but was not associated with the facility and providing caring at the facility. Licensee stated that S1 has been working at the facility since the end of March 2022. Licensee stated that did not receive any kind of Documentation from guardian. LPA reviewed guardian and found S1 not Associated as of 6/14/22 ,

The facility is currently not providing Incidental Medical Services. 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


Cont 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
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: DELMAR FAMILY CHILD CARE
FACILITY NUMBER: 566213327
VISIT DATE: 06/14/2022
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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.

LPA Mathew informed licensee Ana Delmar that this report dated 6/14//2022 document(s) One Type A citation(s) and should be posted for 30 consecutive days. LPA Mathew informed the licensee Ana Delmar to provide a copy of this licensing report dated 6/14/2022 that documents a Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

One Type A deficiency was cited during today's inspection. A civil penalty of $500 has been assessed.. A Technical Violation was issued. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

.Exit interview conducted and report was reviewed with the licensee.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 07/13/2022 04:30 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/11/2022 03:41 PM

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: DELMAR FAMILY CHILD CARE
FACILITY NUMBER: 566213327

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed staff (S1) present and caring for children at the facility. S1 is fingerprinted but is not associated to the facility. S1 stated she has been working at the facility since end of March 2022.
POC Due Date: 06/14/2022
Plan of Correction
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Licensee agreed that Assistant will not be not be at the facility until assistance is cleared. Licensee will submit a written plan how to prevent a similar occurrence in the future. Written plan must be submitted by end of day 7/22/22
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
LIC809 (FAS) - (06/04)
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