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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215588
Report Date: 10/08/2020
Date Signed: 10/08/2020 03:41:09 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:KISSICK FAMILY CHILD CARE AKA LUV BUGS DAYCAREFACILITY NUMBER:
566215588
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
10/08/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:51 PM
MET WITH:Aubrye KissickTIME COMPLETED:
03:40 PM
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On October 08, 2020 at 2:51 PM, Licensing Program Analysts (LPAs) Francisco Pedroza and Maria McDaniels conducted an announced tele-visit Case Management inspection. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPAs met with licensee Aubrye Kissick and discussed the nature and purpose of the inspection. The tele-inspection was conducted via Facetime. During this tele-inspection the applicant provided LPAs a tour of the home. Licensee had five children in care at the time of the inspection.

Licensee submitted an application to the Community Care Licensing (CCL) requesting to become a large family child care facility. The licensee uses one day care room, the living room, and back yard for their day care. On August 25, 2020 the Ventura County Fire Department inspector conducted a fire inspection. The facility received a fire clearance approval for the large family childcare. A 2A10BC fire extinguisher was observed mounted in the closet in the day care room with a purchase date of 07/01/2020. Pediatric CPR and First-Aid certification is current until 6/13/2021. Mandated Reporter training is current until 04/20/2022. Licensee has completed all required licensing requirements to become a large family child care.

Facility license will be a large family childcare effective today, October 8, 2020 for a capacity of 14 children.

A copy of this report was reviewed and provided to the licensees. Licensees agreed to receive a copy of report via email and voiced understanding that the read receipt confirmation from email will be in lieu of their signature once she received the report. LPAs requested licensee to email a copy of signed form for records.

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: 10/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020
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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