566216144-7-14-2021-17-CC-LVIA-C4QRRW-20210708131550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216144
Report Date: 07/08/2021
Date Signed: 07/14/2021 02:49:13 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 FAMILY CHILD CARE		FACILITY NUMBER:	566216144
ADMINISTRATOR:	GUILLERMINA GARCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 253-5679
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	14	CENSUS: 0	DATE:	07/08/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Guillermina Garcia		TIME COMPLETED:	01:15 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	“This is an amended report to change the inspection type from Case Management to Prelicensing inspection.” On July 8, 2021 at 10:00 AM Licensing Program Analyst (LPA) Laura Villanueva to conduct a Prelicensing inspection for a change of location and capacity increase. The previous license number is 566215452. LPA asked COVID-19 pre-entry questions prior to entry. LPA met with Applicant, Guillermina Garcia a tour of the two story home was made both inside and outside. The Applicant will use the play room, living room, kitchen and hall bathroom for the child care. There are age appropriate toys and equipment. The upstairs will be off-limits and has a safety gate at the bottom of the staircase. LPA observed a metal barrier on fireplace. LPA did not observe any toxins/hazardous items accessible to children. LPA did not observe any bodies of water. There is an empty water fountain in the backyard. The regulation fire extinguisher was purchased on 6/23/21. Applicant is reminded to service or purchase the fire extinguisher yearly. The combination smoke/carbon monoxide detector was found to be operational. The applicant will use the backyard for the child care. The yard is completely enclosed by a fence with gates. Applicant’s First Aid/CPR certificates are valid until 06/25/21. Applicant will need to renew Pediatric CPR/First Aid certificate before 8/8/21. Applicant completed the 8-hour Preventative Health and Safety training on 8/19/17. Applicant states that there are no guns/weapons on the premises. LPA informed applicant that she will need parents to sign a waiver for the liability insurance if she doesn't have it (form was provided to Applicant. LPA discussed with and gave applicant a packet of updated samples of state required forms to be kept in the children's file, required forms to be posted and forms that needs to be maintained at the FCCH. LPA also provided Applicant with immunization cards (blue cards), safe sleep pamphlet, capacity requirements form, and LIC9227 Individual Infant Sleep Plan. LPA reviewed SB 792 the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA advised the Flu Vaccine may be completed yearly between August 1 - December 1, or complete a waiver. Continued on LIC809C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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 FAMILY CHILD CARE	FACILITY NUMBER: 566216144
	VISIT DATE: 07/08/2021

NARRATIVE

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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

Applicant 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. Also, Applicant was reminded that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours.

A large family child care license is effective today 7/9/21. A technical violation was issued for expired Pediatric CPR/First Aid see LIC9102.

Inspection and report were translated into Spanish.

A copy of this report and appeal rights were discussed and left with Licensee whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura Villanueva	TELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

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