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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215954
Report Date: 08/25/2021
Date Signed: 08/25/2021 12:32:58 PM

Document Has Been Signed on 08/25/2021 12:32 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:RODARTE FCC AKA EXPRESS DAY CAREFACILITY NUMBER:
406215954
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ana RodarteTIME COMPLETED:
12:00 PM
NARRATIVE
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On 8/25/21, at 9:30 AM, Licensing Program Analyst (LPA) Elvin Baddley made an unannounced Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Ana Rodarte, Licensee of the FCCH and explained the purpose of the inspection. The FCCH's living room, dining room and hallway bathroom are used for child care, while the backyard and remainder of the home will be excluded from child care services. Licensee informed LPA the backyard of the facility is not being used at this time and is no longer accessible to children in care as the entire area is being used for the storage of restaurant equipment. LPA directed the Licensee to provide an updated facility sketch and provided the Licensee the corresponding LIC 999 form. LPA notes the access to the FCCH's backyard is sliding glass door in the living from which is secured by a door lock. LPA observed no children on site at the time of the inspection.

LPA observed FCCH to be free of hazards. LPA observed a fireplace in family room which was screened by a glass covering. The hallway bathroom to be used for children care was observed to be clean and free of toxins. Medication in the FCCH is located in a medicine cabinet in the home's master bedroom and on an elevated shelf in the hallway closet. Each location is inaccessible to children in care. Detergents and cleaning compounds are stored in the FCCH's garage which is inaccessible to children. LPA observed carbon monoxide and smoke detectors in the home. The aforementioned were not tested while LPA was on site as there are individuals sleeping in the FCCH. LPA observed a regulation fire extinguisher on site which was purchased on 2/21/21. LPA reminded Licensee to purchase or have fire extinguisher serviced annually.

As noted the FCCH's backyard is currently excluded from care. LPA observed a jacuzzi in the backyard which was empty and locked by cables.

LPA reviewed a sampling of the children's records. Files reviewed contained no immunization record or emergency consent forms. At 11:15 AM, LPA reminded Licensee of the need to have the aforementioned in the files of children in care. LPA also reviewed the Licensee's records.
(CONT. 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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: RODARTE FCC AKA EXPRESS DAY CARE
FACILITY NUMBER: 406215954
VISIT DATE: 08/25/2021
NARRATIVE
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LPA observed Licensee's Pediatric CPR and First Aid certifications expired on 5/18/21. At 11:25 PM. LPA reminded Licensee of the obligation to have current Pediatric CPR and First Aid certifications .Licensee's Mandated Reporter training is current with an expiration of 3/25/22. LPA observed one dog is on site. LPA reviewed the vaccination record for the dog. The dog's records are current.

Licensee informed LPA no firearm or ammunition is stored on site.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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: www.ada.gov/childqanda.htm

LPA discussed COVID 19 guidance and best practices with the Licensee. Licensee was reminded that it is Licensee's responsibility to know the regulations for a FCCH which can be accessed on-line at www.ccld.ca.gov.

Type B Deficiencies are being cited based on LPA’s observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Licensee. A copy of this report was provided to the Licensee, whose signature is on this form confirms receipt of this document.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY


SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/25/2021 12:32 PM - It Cannot Be Edited


Created By: Elvin Baddley On 08/25/2021 at 11:36 AM
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: RODARTE FCC AKA EXPRESS DAY CARE
FACILITY NUMBER: 406215954

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2021
Section Cited
CCR
102416(c)

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102416(c) Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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LIcensee to complete pediatric CPR and First Aid as soon as possible and followed certification of completion to CCLD
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This requirement was not met as evidenced by record review reveals that licensee first aid andand CPR training certificates expired 5/18/21.

This poses a potential health, safety or personal rights risks to persons in care.
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Type B
08/26/2021
Section Cited
CCR102417(g)(7)

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102417(g) (7) Operation of a Family Child Care Home - An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or
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LIcensee to obtain emergecy contact information and provided to CCL by 8/26/21
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registrant to consent to emergency medical care
This requirement was not met as evidenced by record review reveals Licensee not having remergency consent information form for Child #1 present.
This poses a potential health, safety or personal rights risks to persons in care.
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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:Elvin Baddley
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/25/2021 12:32 PM - It Cannot Be Edited


Created By: Elvin Baddley On 08/25/2021 at 11:58 AM
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: RODARTE FCC AKA EXPRESS DAY CARE
FACILITY NUMBER: 406215954

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2021
Section Cited
CCR
102418(a)

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102418 (a) Immunizations
Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
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LIcensee to obtain immunization record for children and provided proof of such to CCLD by 8/26/21
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This requirement was not met as evidenced by record review reveals Llicensee's not having Immunization records for Child #1 present.

This poses a potential health, safety or personal rights risks to persons in care.
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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:Elvin Baddley
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


LIC809 (FAS) - (06/04)
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