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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215871
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:14:36 PM


Document Has Been Signed on 05/25/2023 04:14 PM - It Cannot Be Edited

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:SALUSTIA GARCIA CLEMENTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 366-9520
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:14CENSUS: 9DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Estella GonzalezTIME COMPLETED:
04:00 PM
NARRATIVE
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On 05/25/2023 at 1:40 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the Family Child Care Home (FCCH). LPA met with Salustia Garica Clemente, licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of licensee toured the interior and exterior of the FCCH. LPA notes eight children (8) children were present at arrival being cared by assistant, Estela Gonzalez. Per assistant, licensee was out picking up children from school. About 15 minutes after arrival, licensee arrived with three (3) additional children, two (2) of whom are licensee’s children.

This is a single-story home with two (2) bedrooms, one (1) bathroom, living room, dining room/kitchen, garage with laundry room, and outdoor yard. The day-care services occur in the living room, one (1) bathroom in the hallway of the home, and part of the outdoor yard. Meanwhile, the kitchen/dinning room, two (2) bedrooms, garage with laundry room and part of the outdoor yard are inaccessible to children in care. LPA notes there is a baby gate that makes the kitchen, dining room, garage, and laundry room inaccessible. LPA observed both bedrooms to have a locked door. Additionally, the sides of outdoor yards have fencing making the sides of the outdoor yard inaccessible to children in care.

LPA observed the home to be clean and orderly. There is plenty of ventilation to afford the children comfort. LPA observed sharps are stored in an elevated cabinet in the kitchen. Cleaning compounds are stored in an elevated cabinet in the kitchen, in the laundry room and in and outdoor shed. Medication for the family is stored in an elevated cabinet in the kitchen. LPA notes all areas are inaccessible to children in care by means of baby gate or locks. The restroom that is used for childcare services is clean and free of toxins. In the FCCH, LPA observed toys, furniture, and equipment are in good conditions and are age appropriate for the children in care.

CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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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Document Has Been Signed on 05/25/2023 04:14 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 6 out of the 8 children present were not documented in the facility roster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2023
Plan of Correction
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Licesnee agrees to update her facility roster and add all missing children on facility roster. Licensee understands that upon enrollment of new children, their information must be added to the facility roster to ensure it is current and up to date. Licensee will email updated roster to LPA's email at Francisca.Velazquez@dss.ca.gov by June 1, 2023.
Type B
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that at arrival there were eight children being supervised by one adult (3 infants, 1 school age and 4 children that were older than 2 years but not school age yet) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2023
Plan of Correction
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Licensee understand that when one adult is present, ratios and capacities for a Small FCCH must be followed. Licensee agrees to submit a written plan detailing how she will ensure this regulation is being folllowed. Licensee will sbumit written plan to LPA's email at Francisca.Velazquez@dss.ca.gov by June 1, 2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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: GARCIA CLEMENTE FCC AKA GRACE FCC
FACILITY NUMBER: 566215871
VISIT DATE: 05/25/2023
NARRATIVE
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Required forms are predominantly posted in the living room. LPA observed a combination smoke and carbon monoxide detector in the FCCH that were tested at 3:10 PM and was operable during this inspection. LPA observed the home has a regulation fire extinguisher that was purchased on 01/08/2023. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services. Licensee informed LPA no guns or ammo are stored in the home.

LPA observed the outdoor yard to be completely fenced. LPA observed the exit doors to be secured. LPA observed daycare children have access to part of the yard. LPA observed the sides of the outdoor yard are made inaccessible by means of permanent fencing separating the outdoor yard. The outdoor yard provides plenty of shading for the children in care. LPA observed one shed that is secured and locked. Filtered drinking water is provided by means of individual cups that are labeled. Toys, furniture, and equipment observed in the outdoor yard are age appropriate and in good conditions. No bodies of water are observed.

LPA reviewed Licensee, assistant, and children's records. The children’s records were found to contain emergency contact information as well as immunization records, but two out of the eight children present did not have parent rights. Licensee is documenting infant 15-minute sleep logs for all children under the age of two (2) years and all children under the age of one (1) have infant sleep plans. After reviewing facility roster, six out of the eight children present are not documented in the facility roster. The last emergency drill was conducted and documented on 05/10/2023. LPA reviewed Licensee’s Pediatric First -aid certificate that is valid until 09/20/2023 and Licensee's Mandated Reporter training certification is valid until 09/09/2025. Assistants’ file was reviewed and current with Pediatric First -aid certificate that is valid until 04/01/2025 and Mandated Reporter training certification is valid until 05/02/2025.

At 1:38 PM, LPA observed one infant that was napping in a playpen with a blanket and infant toy. Per licensee, infant is attached to the blanket and since children are observed during nap, license thought it would be fine.

At arrival, LPA observed assistant providing care for eight (8) children. After file review it was determined that there are three infants, one school age child and four children that are older than two years of age but not school age making assistant out of capacity.

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. CONT 809C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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: GARCIA CLEMENTE FCC AKA GRACE FCC
FACILITY NUMBER: 566215871
VISIT DATE: 05/25/2023
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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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an for additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

During today’s inspection Type B deficiencies are being cited. Appeal right were provided to licensee. Exit interview conducted and report was reviewed with the Licensee, Salustia Garcia Clemente in Spanish due to Spanish being the licensee’s primary language. A Notice of Site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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