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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215871
Report Date: 11/23/2021
Date Signed: 12/14/2021 12:08:38 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:SALUSTIA GARCIA CLEMENTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 366-9520
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:14CENSUS: 14DATE:
11/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Salustia Garcia ClementeTIME COMPLETED:
12:15 PM
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On November 23, 2021 at 10:00 AM Licensing Program Analyst (LPA), Laura Villanueva conducted an unannounced inspection to complete an annual required visit. Prior to inspection, LPA Villanueva asked pre screening questions related to COVID-19, Licensee's response indicates there are no COVID-19 exposures on site. LPA toured the home with Licensee, Salustia Garcia Clemente. There were 14 children present with Licensee and her Assistant.

The home is a single family home with 2 bedrooms and 1 bathroom. The Licensee uses the living room, kitchen, and hall bathroom for the child care. There are no guns or ammunition on the premises. No toxins or hazards are accessible to the children in care. Cleaning supplies are stored on top of a locked upper cabinet in the kitchen. The required fire extinguisher was purchased on 12/20/20. Licensee's Pediatric CPR /First Aid certificate expires 9/21/23. Mandated reporter training was completed on 10/26/20. Child files were found to be complete. The child roster was up to date. There combination smoke and carbon monoxide detector is located in the living room. Last fire drill was conducted on 9/30/21.

The facility is currently providing Incidental Medical Services. Incidental Medial Services (IMS). The center provides IMS but currently does not have any children with medication. For additional IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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.

Continued on LIC809C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
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: GARCIA CLEMENTE FCC AKA GRACE FCC
FACILITY NUMBER: 566215871
VISIT DATE: 11/23/2021
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LPA provided Licensee with safe sleep regulations, LIC9227, sleep charting sheet, and AB 2370 Lead Bill Flyer.

Exit interview conducted with Licensee Salustia Garcia Clemente and a copy of this report was given. No citations issued today.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process


THE NOTICE OF SITE VISIT WILL BE 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) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
LIC809 (FAS) - (06/04)
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