566213856-8-3-2021-17-CC-BCES-C5JTBB-20210803143451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566213856
Report Date: 08/03/2021
Date Signed: 08/03/2021 02:34:57 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:	CERVANTES FAMILY CHILD CARE		FACILITY NUMBER:	566213856
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	08/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Evangelina Cervantes		TIME COMPLETED:	02:40 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 August 3, 2021 at 1:00PM, Licensing Program Analyst (LPA) Betzayra Cervantes conducted an unannounced visit for the purpose of performing a Required- 1 Year and Case Management - Licensee Initiated inspection. LPA spoke to licensee Evangelina Cervantes and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. License and LPA toured the facility inside and outside. Three fingerprint cleared adult residents and four children were in care at the time of the inspection. This facility is a one story home with four bedrooms and two bathrooms. Licensee is utilizing the home’s play room, living room, dining room, backyard, and one restroom while kitchen while the three bedrooms, and garage are off limits. LPA observed age appropriate toys and furnishings available for children in care. The backyard has sufficient shade and age appropriate toys for children in care, found in good condition and free of hazards. LPA observed the backyard to have a fenced off portion which is off limits and made inaccessible with a key lock. This area had 2 RV vehicles used for storage and miscellaneous gardening and tools. Children do not have access to this side of the yard given it is locked. The smoke alarm & Carbon Monoxide were tested and found operational. A regulation 2A10BC fire extinguisher was serviced on 3/2/2021 and was observed mounted on the kitchen wall. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA observed the home to be clean, orderly and void of hazardous items. The bathroom used by children in care is clean and free of toxins. LPA observed a child safety gate at the entrance of the kitchen preventing children from having access. Cleaning compounds are located under the kitchen sink and in the detached garage outside of the home. Toys and equipment observed in the FCCH are age appropriate. (CONT. 809-C)

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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: CERVANTES FAMILY CHILD CARE	FACILITY NUMBER: 566213856
	VISIT DATE: 08/03/2021

NARRATIVE

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A sampling of the children records were reviewed. The records were current and complete. A current roster of children was reviewed by the LPA and found up to date. The Licensee's records are also current and complete with Pediatric CPR and First Aid certifications valid until 6/16/2023 and Mandated Reporter training expiring on 7/28/23. Licensee states that there are no firearms and ammunition in the home. LPA did not observe any bodies of water.

Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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: www.ada.gov/childqanda.htm.

LPA discussed COVID- 19 guidance and best practices with the Licensee. Licensee was provided PIN 20-24-CCP - Recently Approved Safe Sleep Regulations In Effect and LIC 9227 (Infant Sleeping Plan) via email. Licensee was reminded that it is Licensee's responsibility to know the regulations for a FCCH which can be accessed on-line at www.ccld.ca.gov.

In areas evaluated, there were no deficiencies cited at this time. Fire clearance was granted for 14 children by the Oxnard Fire Department on 6/10/21.

The home meets Title 22 of Community Care Licensing requirements for a Large Family Child Care License effective today, August 3, 2021. Exit interview was conducted with licensee Evangelina Cervantes. A copy of this report was reviewed and provided to the applicant

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 Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

LIC809 (FAS) - (06/04)

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