<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406207483
Report Date: 11/04/2022
Date Signed: 11/07/2022 10:09:26 AM

Document Has Been Signed on 11/07/2022 10:09 AM - 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:JAZO FAMILY CHILD CAREFACILITY NUMBER:
406207483
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Mireya Jazo TIME COMPLETED:
12:30 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
On 11/4/2022, at 10:15 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted a Required Inspection of the facility. Prior to entering the facility, LPAs completed COVID-19 pre-screening questionnaire with Licensee and based on Licensee's responses it was determined that facility did not have COVID-19 exposures. LPA met with Mireya Jazo, Licensee of the facility and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the facility. The home’s living room, kitchen, bathroom and front yard are used for childcare, while the home’s three bedrooms and backyard are excluded. At the time of the inspection 4 children are present.

The home was orderly and free of toxin. LPA observed that there is a baby gate making the bedrooms inaccessible to children in care. LPA observed that the children do not have any access to the back outdoor yard. LPA observed the bathroom used for care was clean and free of toxins with hand washing poster for the children. LPA observed two open face heaters in the play area that are covered. In the living room, LPA observed a fireplace that is covered and secured with large furniture. LPA observed sharps are stored in an elevated cabinet in the kitchen. LPA observed cleaning compounds are stored under the sink of the bathroom and kitchen in locked cabinets. Licensee stated that household medications are stored in Licensee's bedroom that is inaccessible to children in care. Toys, furniture, and equipment in the facility are age appropriate.

LPA observed required licensing forms and documents post on the wall of the living room in the facility. LPA observed smoke detector on the ceiling of the kitchen and carbon monoxide located on the hallway of the home. Both smoke detector and carbon monoxide detector were tested at 11:00 AM and were found to be operational. LPA observed a regulation fire extinguisher in the kitchen area that was serviced 1/14/2022. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPAs revised the home’s fire/disaster drill log. The most recent fire drill conducted and documented on 9/28/2022.

Licensee uses the front yard as an outdoor play area. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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 3
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: JAZO FAMILY CHILD CARE
FACILITY NUMBER: 406207483
VISIT DATE: 11/04/2022
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
26
27
28
29
30
31
32
The front yard is fence and has plenty of shade for the children in care. LPA observed plenty of gross motor activities for children in care. Water is provided by means of water pitchers and cups. Licensee reported children are taken on walks to nearby park. LPA advised Licensee to always practice active supervision at all times when children are taken out of the home. Toys and play equipment observed in backyard are age appropriate. LPA observed no bodies of water on site.

Licensee informed LPA no firearms or ammunition are stored on site.



LPA reviewed a sampling of the children records. All records reviewed are current and contains complete emergency card information. Facilities current roster of children was reviewed by the LPA during inspection. All children present during the inspection are noted in the roster. LPA reviewed the Licensee's Pediatric CPR and First Aid certifications which expires 3/22/2024 and Mandated Reporter training expiring on 10/4/2024.

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

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. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: JAZO FAMILY CHILD CARE
FACILITY NUMBER: 406207483
VISIT DATE: 11/04/2022
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
26
27
28
29
30
31
32
No deficiencies were cited during today’s inspection.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Mireya Jazo in Spanish due to Spanish being the Licensee primary language.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3