566215940-7-16-2020-17-CC-MAVA-BRKMW7-20200716095751

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215940
Report Date: 04/29/2020
Date Signed: 07/16/2020 09:58:31 AM

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:	LEDEZMA FAMILY CHILD CARE		FACILITY NUMBER:	566215940
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/29/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:51 AM
MET WITH:	Irma Ledezma		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michael Avila conducted an announced tele-visit for the purpose of performing a pre-licensing inspection. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPA Avila conducted the tele-inspection via Face Time and met with Licensee Irma Ledezma and discussed the nature and purpose of the visit. LPA Avila asked and Licensee denied having anyone in the home who exhibited any symptoms associated, or had been exposed to a person known to have been diagnosed, or was infected with COVID - 19. LPA Avila, with the assistance of Licensee, conducted a virtual tour of the interior and exterior of the home. The home is a three bedroom, two bath single story single dwelling with an attached garage. The 3 bedrooms have been excluded as off-limits. LPA observed the home to be orderly. No toxins nor hazards are accessible to children in care. Detergents and cleaning compounds are stored out of reach of children. Medication and sharps in the home are stored on elevated shelves in the kitchen's cabinets. The bathroom to be used for children care was observed to be clean and free of toxins. LPA observed a combination carbon monoxide/smoke alarm detector affixed to the hallway. The detector was tested and found to be operable. LPA reminded the Applicant Family Child Care Homes (FCCH) must maintain operable carbon monoxide and smoke alarm detector at all times. LPA observed a fire extinguisher on site which was purchased on March 6, 2020. LPA reminded applicant that required licensing forms and documents must posted clear and conspicuous area for public to view. The outdoor play area is fully enclosed with a fence. No bodies of water were observed on site. CONT. 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael Avila	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2020

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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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: LEDEZMA FAMILY CHILD CARE	FACILITY NUMBER: 566215940
	VISIT DATE: 04/29/2020

NARRATIVE

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The applicant completed Preventative Health training on February 8, 2020. Applicant’s Pediatric CPR and First Aid certificate expires on February 3, 2020. Applicant informed LPA no firearm or ammunition is stored on site. LPA reviewed a rental agreement to verify control of property. Applicant states the home does not have liability insurance. LPA informed applicant parents will need to sign a waiver for the liability insurance (applicant was provided form-LIC 282).

Applicant is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. 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 will issued the applicant updated samples of state required forms to be kept in the children's record. LPA also discussed and provide the applicants Guidelines to Safe Sleep and Effects of Lead Exposure leaflets. Applicant was informed that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. Applicants were made aware of the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

Licensure is pending the following:

1. Licensee must sign and return a copy of this pre-licensing report.
2. Upon receipt of this signed pre-licensing report, a small Family Child Care Home License will be approved.

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 Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael Avila	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2020

LIC809 (FAS) - (06/04)

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