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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213572
Report Date: 03/12/2020
Date Signed: 03/12/2020 01:40:56 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:VILLANUEVA FCC AKA KIDS WORLDFACILITY NUMBER:
566213572
ADMINISTRATOR:S, VILLANUEVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 297-6005
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:14CENSUS: 10DATE:
03/12/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sylvia VillanuevaTIME COMPLETED:
12:19 PM
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On March 12, 2020 at 10:49 am, Licensing Program Analysts (LPAs) Francisco Pedroza and Maria McDaniels conducted a Required Annual inspection. LPAs met with licensee Sylvia Villanueva and advised her the purpose of the visit. LPAs and licensee together toured the home inside and out. Licensee has a four bedroom home. There were 10 children in care at the time of the inspection.

The licensee uses the kitchen, family room, one restroom, and back yard for the day care. Licensee states that there are no fire arms and ammunition in the home. LPAs did not observe toxins/hazards accessible to children in care. LPAs observed fireplaces in off limit rooms that were secured preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The home has a dual working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed mounted in the kitchen with a last service date of 10/2/2019. The backyard is fully enclosed with concrete wall. Licensee has a wooden fence splitting the back yard in half. One half of the back yard is for the children and day care. The second half is off limits to the children. There is an outdoor storage unit in the back yard that is secured. Licensee has age appropriate toys and play structure in the backyard readily accessible to children. Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: VILLANUEVA FCC AKA KIDS WORLD
FACILITY NUMBER: 566213572
VISIT DATE: 03/12/2020
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A roster of children in care was observed current and complete. A sampling of children records was reviewed and found current. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Licensee does not have liability insurance for their facility. Children had required liability waivers in their files. Pediatric First-Aid and CPR is current until 11/21/2021. Mandated Reporter training is current until 2/8/2022. The Fire/Emergency drill was completed on 12/2/2019. LPA discussed Incidental Medical Services (IMS) with licensee. Licensee currently does not have children in care that require IMS. LPA discussed and provided licensee AB 2370 Lead Exposer guide and Safe Sleep pamphlet.

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

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS 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 MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
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