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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215871
Report Date: 10/16/2019
Date Signed: 10/16/2019 01:24:43 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:GARCIA CLEMENTE FCC AKA GRACE FCCFACILITY NUMBER:
566215871
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
10/16/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Salustia Garcia ClementTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Michael Avila made an announced visit to conduct a Pre-Licensing Inspection. LPA met with applicant, Salustia Garcia Clement and discussed the nature and purpose of the visit. explained the nature, purpose and scope of the inspection.

LPA toured the interior and exterior of the home with the applicant. The home is a single story 2 bedroom, 1 bath with an attached garage. Applicant advises the garage will be off limits to children in care. No toxins or hazards were observed accessible to children in care. Age appropriate toys and furniture were observed in the rooms children will be cared for.

The LPA observed a functioning combination carbon monoxide / smoke alarm detector affixed to the home’s main hallway wall as well as a 2A10BC fire extinguisher on site which was serviced on 9/19/19. The outdoor play area/backyard is completely enclosed with a fence. No bodies of water were observed on site.

Given applicant is monolingual Spanish speaking, she has not yet completed the Mandated Reporter Training but will do so when a class can be offered in Spanish. The applicant completed Preventative Health training on 08/24/2019. The Applicant’s Pediatric CPR and First Aid certificate expires 09/16/2021. The applicant stated there are no guns or ammunition in the home.

Applicant is not providing Incidental Medical Services. 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

Approval of a Family Child Care Home is pending receipt of copy of rental contract to confirm control of property.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1
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: GARCIA CLEMENTE FCC AKA GRACE FCC
FACILITY NUMBER: 566215871
VISIT DATE: 10/16/2019
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the outdoor play area is sufficient for the capacity of the FCCH, varied and age appropriate. The outdoor play area is also free of hazards. Additionally, no bodies of water were observed on site.

Given applicant is monolingual Spanish speaking, she has not yet completed the Mandated Reporter Training but will do so when a class can be offered in Spanish. The applicant completed Preventative Health training on 08/24/2019. The Applicant’s Pediatric CPR and First Aid certificate expires 09/16/2021. The applicant stated there are no guns or ammunition in the home.

Applicant is not providing Incidental Medical Services. 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

LPA discussed AB 633 and handed Pre-licensing packet to applicant. The LPA reviewed and issued the applicant updated samples of state required forms to be kept in the children's record. The LPA also discussed and provide the applicant information of Sudden Infant Death Syndrome, Guidelines to safe sleep and Never Shake a Baby brochure. The Applicant was informed that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. Applicant has 2 pet dog which are licensed and vaccinated. Applicant was made aware that it is their responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

No deficiencies cited during this visit. License to operate a Family Child Care Home is effective today, 9/20/19. .

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: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 1 of 1