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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215685
Report Date: 11/30/2022
Date Signed: 11/30/2022 01:24:29 PM

Document Has Been Signed on 11/30/2022 01:24 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:DIAZ FCC AKA WAYS OF ALOHA DAYCAREFACILITY NUMBER:
406215685
ADMINISTRATOR:JESSICA DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 471-5224
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Jessica DiazTIME COMPLETED:
01:38 PM
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On November 30, 2022 at 12:05 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with licensee Jessica Diaz and advised her the purpose of the inspection. Licensee provided LPA a tour of the home. There was 10 children in care and one (1) assistant providing supervision.

Licensee has a single story home. They use the living room, dining room, one (1) bathroom, one (1) bedroom, and the backyard for children in care. The other bedrooms, kitchen, and garage are off-limits to children in care. Licensee has a gate at the entrance of the kitchen and hallway preventing children from having access. A fireplace was observed in the living room with the opening blocked off preventing children from having access. Licensee has chemical/disinfectants stored in the hallway with a secured door preventing access. LPA observed a 2A10BC fire extinguisher was observed mounted on the wall in the kitchen with a service date of 12/17/21. Licensee advised to service or purchase the fire extinguisher annually. LPA observed working smoke and carbon monoxide detectors. LPA observed age appropriate toys, books, furniture, and accessories readily accessible for children. Licensee provides infants travel cribs and older children sleeping mats to sleep on. The backyard is enclosed with a wood fence. LPA observed age appropriate toys, bicycles, and play structures readily accessible for children. Licensee has rabbits in the backyard. Licensee confirmed they do not have firearms or live ammunition in the home.

LPA observed a sampling of children and staff records. Children records were found to be current and complete. LPA observed liability insurance waivers in the children records. Staff records were found to be current and complete. Licensee's Pediatric CPR/First-Aid expires on 10/26/24. Licensee's AB1207 Mandated Reporter expires on 4/13/23. LPA spoke with licensee about current Safe Sleep and Covid-19 requirements. Currently licensee is following Safe Sleep and Covid-19 requirements.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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: DIAZ FCC AKA WAYS OF ALOHA DAYCARE
FACILITY NUMBER: 406215685
VISIT DATE: 11/30/2022
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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 Home 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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 additional resource. LPA also informed licensee [facility representative] 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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