566214976-9-28-2021-17-CC-ARIS-C7AP4P-20210928105929

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566214976
Report Date: 09/28/2021
Date Signed: 09/28/2021 10:59:34 AM

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:	BAUTISTA FAMILY CHILD CARE		FACILITY NUMBER:	566214976
ADMINISTRATOR:	ROSA R. BAUTISTA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 816-3371
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY:	14	CENSUS: 4	DATE:	09/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Rosa Bautista		TIME COMPLETED:	11:06 AM

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On September 28, 2021 at 9:35 AM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced annual inspection. LPA conducted Covid-19 screening questions prior to entering the home. LPA met with licensee Rosa Bautista and discussed the nature and purpose of the inspection. Together both licensee and LPA conducted a tour of the home inside and outside. There was four children in care at the time of the inspection.

The home is a single story residence and licensee uses the family room, dining room, one restroom, and backyard for the day-care. LPA observed door to the hallway bedrooms was locked. LPA also observed a gate in front of the kitchen preventing children from having access. There are no bodies of water in the home. Licensee states that there are no firearms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. In the family room, LPA observed a fireplace with a shelf in front of it preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The backyard is fully enclosed with a fenced wall. Licensee has age appropriate toys and play structures in the backyard in good condition and free of hazards.

The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the kitchen with a purchase date of 10/2/2020. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 7/26/2023. Licensee has AB 1207 Mandated Reporter Training Certificate on file.

Continued on 809-C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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: BAUTISTA FAMILY CHILD CARE	FACILITY NUMBER: 566214976
	VISIT DATE: 09/28/2021

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All required forms are prominently posted for parent's or authorized representatives to view in the dining room. A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete. LPA observed Identification and Emergency Notification forms (LIC 700).

LPA spoke with licensee regarding safe sleep regulations and provided licensee with safe sleep forms.

Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

LIC809 (FAS) - (06/04)

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