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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213816
Report Date: 11/21/2019
Date Signed: 11/21/2019 02:31:31 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:SEGOVIA FCC AKA THE SEGO BUNCHFACILITY NUMBER:
566213816
ADMINISTRATOR:SUSANA & GILBERT SEGOVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 421-3476
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY:14CENSUS: 12DATE:
11/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Susana SegoviaTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Laura Villanueva made an unannounced Random ANNUAL visit to the home. Met with Licensee, Susana Segovia and explained the purpose of the visit. A tour of the one story home was made inside. The Licensee uses the living room, dining room, play room and bathroom for the day care. The Licensee states that they do not use the backyard due to the pool. The kitchen/dining room and Master bedroom have sliding doors that lead onto the backyard and all these sliders have mounted locks at the top. LPA verified the locks are operable. Licensee understand that these doors must be maintained as locked at all times and that the backyard must be off limits at all times during child care hours of operation.

The fireplace in the living room is screened making it inaccessible to children The bedrooms are closed making them inaccessible to children in care. The toxins are stored on a top cabinet in the kitchen making them inaccessible to the children. The regulation fire extinguisher was purchased on 11/2/19. Licensee is reminded to either service or purchase a regulation fire extinguisher every year. The smoke detector and the carbon monoxide detector were observed to be functional. There are age appropriate toys and equipment. LPA reviewed the children roster. The last fire drill was done on 10/22/19. Licensee's First Aid/CPR certificates are valid through 1/27/20. Licensee states that she does not have any guns/weapons on the property. LPA reviewed SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements).Licensee is current. Licensee has completed the Mandated Reporter Training on 4/4/17. Licensee will renew Mandated Reporter Training. Assistant will be completing Mandated Reporter Training.

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

Continued on LIC 809C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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: SEGOVIA FCC AKA THE SEGO BUNCH
FACILITY NUMBER: 566213816
VISIT DATE: 11/21/2019
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Licensee is reminded that she is responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov.

LPA reviewed and provided Licensee with Guide to Infant Safe Sleep, Lead Poisoning Flyer and Child Care Quarterly Update-Fall 2019.

No deficiencies were cited during today's visit.

The LIC 9213 (Notice of Site visit) was posted 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: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
LIC809 (FAS) - (06/04)
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