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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406213712
Report Date: 03/18/2025
Date Signed: 03/18/2025 03:43:14 PM

Document Has Been Signed on 03/18/2025 03:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SIVERLING FAMILY CHILD CAREFACILITY NUMBER:
406213712
ADMINISTRATOR/
DIRECTOR:		SARAH MAE SIVERLINGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 439-0519
CITY:LOS OSOSSTATE: CAZIP CODE:
93402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
03/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Sarah SiverlingTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
NARRATIVE
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On 3/18/25, at 2:30 PM, Licensing Program Analyst (LPA) Shane Loftus conducted an unannounced Annual/Random Inspection and met with Sarah Siverling, Licensee of the above-mentioned Family Child Care Home (FCCH). LPA informed Licensee of the nature and purpose of the inspection. LPA, in the company of the Licensee, toured the exterior and interior of the FCCH. The FCCH's living room, dining room, playroom, bathroom, and backyard are used for child care services, while the remainder of the home is excluded from care. LPA notes there is a child safety gate at the base of the stairs leading to the second story. At the time of the inspection, LPA observed 3 children in care.

LPA observed the FCCH to be clean and orderly. The FCCH has spacing and ventilation for children in care. LPA observed a fireplace on site which has a glass screen. LPA observed the bathroom to be used for children in care to be clean and free of toxins. Medication is stored in an elevated kitchen cabinet. Sharps in the FCCH are stored on an elevated kitchen shelf. Cleaning compounds are secured underneath the kitchen sink.

LPA observed required licensing documents and notices posted in the FCCH. LPA observed a fire extinguisher (2A10BC) which was serviced on 3/17/25. LPA reminded Licensee of the responsibility to service or purchase a regulation fire extinguisher annually. The home has numerous smoke and carbon monoxide detectors. A smoke detector in the home was tested at 2:40 PM and found to be operable, while a carbon monoxide detector in the home was tested at 2:45 PM and found to be operable. The FCCH has age-appropriate toys and play equipment available to children in care.

The residence's backyard is enclosed by wooden fencing. Footing in the area is varied. The fences entry/exit gates are secured. The area contains a guest room that remains locked during child care. The backyard is partitioned so that the side yards are inaccessible to children. The backyard also has shade created by trees and building over hangs. LPA observed a jacuzzi on site that is latched and secure. Cont. on 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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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Document Has Been Signed on 03/18/2025 03:43 PM - It Cannot Be Edited


Created By: Shane Loftus On 03/18/2025 at 03:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SIVERLING FAMILY CHILD CARE
FACILITY NUMBER: 406213712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Russell Siverling does not have current Mandated Reporter training (AB1207), this poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
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Licensee will submit proof of completed mandated reporter training for the staff in question to CCLD (shane.loftus@dss.ca.gov) by 3/31/25.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Shane Loftus
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: SIVERLING FAMILY CHILD CARE
FACILITY NUMBER: 406213712
VISIT DATE: 03/18/2025
NARRATIVE
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LPA reviewed a sampling of children's and staff records. The children's records were current and complete containing emergency contact information and immunization records. At 3:00 PM, LPA notes A2 does not have current Mandated Reporter (AB1207) training. The remainder of the staff’s records were found to be current with CPR/First Aid training and immunization records. The FCCH has a firearm on site that is locked and secured. There is no ammunition on the property. LPA reviewed the FCCH's Fire Drill log which noted the last fire drill occurred on 1/10/2025.

The Licensee does not provide Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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 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 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.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Cont. on 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: SIVERLING FAMILY CHILD CARE
FACILITY NUMBER: 406213712
VISIT DATE: 03/18/2025
NARRATIVE
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Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 3/18/24.

Today, a Type B deficiency is cited under Title 22, Division 12. Appeal Rights were provided.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Sarah Siverling.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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