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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213654
Report Date: 09/04/2019
Date Signed: 09/04/2019 03:35:01 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:MADRIGAL FCC AKA EMILY'S PAMPERED TOT'SFACILITY NUMBER:
566213654
ADMINISTRATOR:MARIA MADRIGALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 766-2276
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY:14CENSUS: 2DATE:
09/04/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Maria MadrigalTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Laura Villanueva and Betzayra Cervantes conducted a Case Management-Deficiencies visit. LPAs toured the home with Licensee. Licensee is in the process of remodeling the upstairs. The side yard is gated containing the demolished items from the remodel. The outdoor pool is completed fenced in compliance with regulations.


During the toured of the home, LPAs observed observed hairspray in a bedroom and in a hall room leading into the playroom. There was a gate at the bottom of the stairs making the second floor inaccessible to the children. The playroom was free of toxins and hazards.


On 8/12/19 LPA Villanueva conducted an annual random visit. Licensee needed to submit renewed CPR/First Aid card, date of current fire drill, Mandated Reporter Training, and Daughter's fingerprints and TB test results. Licensee has completed CPR/First Aid training on 8/20/19. The items that were not completed are cited on LIC 809D.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
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 3
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: MADRIGAL FCC AKA EMILY'S PAMPERED TOT'S
FACILITY NUMBER: 566213654
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2019
Section Cited

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The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.

This requirement was not met as evidenced by: Last fire drill was conducted on 1/1/17.
Type B
09/04/2019
Section Cited

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ยง1596.8662 Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion


This requirement was not met as evidenced by: Licensee has not completed Mandated Reporter Training.

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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) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: MADRIGAL FCC AKA EMILY'S PAMPERED TOT'S
FACILITY NUMBER: 566213654
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2019
Section Cited

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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.

This requirement was not met as evidenced by: Licensee's daughter turned 18 years old on 8/6/19 and she has not been fingerprinted.
Type A
09/04/2019
Section Cited

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(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement was not met as evidenced by: Hairspray was accessible to the children in the bedroom and in a hallway room.


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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) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3