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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215804
Report Date: 07/22/2019
Date Signed: 07/22/2019 12:23:01 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:VILLEGAS FAMILY CHILD CAREFACILITY NUMBER:
566215804
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
07/22/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Carmen VillegasTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Laura Villanueva made a PRELICENSING visit to the home. Met with Applicant Carmen Villegas. A tour of the one story home was made both inside and outside. The Applicant will use one bedroom, living room, kitchen and hall bathroom for the day care. There are age appropriate toys and equipment. LPA did not observe any toxins/hazardous items accessible to children. The regulation fire extinguisher was serviced on 6/3/19. Applicant is reminded to service or purchase the fire extinguisher yearly. The smoke and carbon monoxide detector was found to be operational. The applicant will be using a side yard for the children. It is fenced in partially. Applicant will need to supervise children while in the yard. Applicant’s 1st Aid/CPR certificates are valid until 5/6/19. Applicant completed the 8-hour Preventative Health and Safety training on 4/13/19. Applicant states that there are no guns/weapons on the premises. LPA informed applicant that she will need parents to sign a waiver for the liability insurance if she doesn't have it (form was provided to Applicant). LPA discussed with and gave applicant a packet of updated samples of state required forms to be kept in the children's file, required forms to be posted and forms that needs to be maintained at the FCCH. LPA also provided Applicant with immunization cards (blue cards), safe sleep pamphlet, poisonous plants poster, capacity requirements form, lead poising pamphlet, and Child Care quarterly updates.

Incidental Medical Services (IMS) policy was discussed. 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

Applicant was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. Also, Applicant was reminded that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019
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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