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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215940
Report Date: 12/27/2021
Date Signed: 12/27/2021 03:57:34 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:LEDEZMA FAMILY CHILD CAREFACILITY NUMBER:
566215940
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Irma LedezmaTIME COMPLETED:
01:00 PM
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On December 27, 2021 at 11:20 AM Licensing Program Analysts (LPAs) Laura Villanueva and Michael Mathew conducted an annual random inspection and met with Licensee, Irma Ledezma. LPAs informed Licensee of the purpose of the 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. LPAs toured the home inside and outside with Licensee. The main child care areas are kitchen, living room, and hall bathroom. The 3 bedrooms are locked and off limits to the children. LPAs observed age appropriate toys and equipment in living room. The backyard is completely fenced. LPAs observed the child care area to be clean and orderly. Cleaning products and all potentially hazardous items are stored inaccessible to children in a high cabinet in the kitchen.

Licensee stated there are no firearms/ammunition or bodies of water accessible to children. Licensee stated that all adults residing in the home have a criminal record clearance. The fire extinguisher was purchased on 6/25/21. Licensee was reminded the fire extinguisher needs to be serviced or replaced yearly. Licensee is current with Pediatric CPR and First Aid which expires 2/03/22 The last fire drill was conducted 12/17/21. Licensee was reminded to conduct fire and disaster drill at least once every six months and document the date and time of each drill. Children’s roster reviewed and found to complete. The smoke alarm and carbon monoxide detector were found to be present. Licensee is current with requirements for immunization required per SB 792.

Licensee 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

Continued on LIC809C

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

DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021
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 2
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: 12/27/2021
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LPAs provided Licensee with LIC 9227, safe sleep tracking log, PIN 20-22. LPA's conducted an exit interview with Licensee and provided a copy of this report. Report was translated into Spanish.

No deficiencies were cited today.

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

DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021
LIC809 (FAS) - (06/04)
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