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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216030
Report Date: 11/07/2022
Date Signed: 11/08/2022 09:40:15 AM

Document Has Been Signed on 11/08/2022 09:40 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:CAZARES FAMILY CHILD CAREFACILITY NUMBER:
406216030
ADMINISTRATOR:ROCIO LOPEZ-CAZARESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 835-6190
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
11/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rocio Lopez-CazaresTIME COMPLETED:
03:35 PM
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On 11/7/22, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Rocio Lopez-Cazares, Licensee of the FCCH and explained the purpose of the inspection. LPA notes COVID Pre-screening questions were asked of Licensee prior to the inspection. The Licensee's responses suggest the FCCH is void of COVID positive cases. At the time of the inspection, LPA observed three (3) child on site along with Licensee and Jesus Carmona, assistant and spouse of Licensee.

LPA, in the company of Licensee toured the interior of the FCCH. This home consists of one (1) bedroom and one (1) bathroom. The FCCH’s living room, kitchen, and one (1) bathroom in the hallway are accessible for childcare services. Meanwhile, Licensee’s bedroom is off-limits and made inaccessible by safety latch.

The FCCH was observed to be clean and orderly. The FCCH has ventilation to afford for the children’s comfort. The FCCH was void of hazardous items. LPA observed sharps, medication for the family and cleaning compounds are stored in different elevated cabinets in the kitchen of the home. Additionally, more cleaning compounds are in bathroom in an elevated shelf. LPA observed all areas are inaccessible to children in care. The bathroom used for childcare is clean and free of toxins. Toys, furniture, and equipment in the FCCH are age appropriate.

Required forms are predominantly posted on the entrance of the FCCH. LPA observed a combination smoke and carbon monoxide detectors in the FCCH. The detector was tested at and found to be operable at 12:45 PM. The FCCH has a regulation fire extinguisher on site which was purchased on 01/05/2022. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services.

LPA notes that this home is in a mobile park and therefore the home does not have an outdoor play area.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2022
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 4
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: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 406216030
VISIT DATE: 11/07/2022
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Licensee states that Licensee stays home with the little children and spouse/assistant sometimes takes the older children to the park. LPA advised for active supervision of all children when they are out of the home.

LPA reviewed children's records. The records are current, complete and possessed emergency contact information and immunization records. Licensee has documentation memorializing infant sleep checks in intervals of 15 minutes. A review of the FCCH's fire drill log shows the last drill occurred on 11/4/22. The Licensee's records were reviewed. Licensee’s pediatric CPR and First Aid certification expires on 8/6/2024. Licensee’s Mandated Reporter training certificate expired 8/30/2022. Licensee stated that she forgot that mandated certificate needs to be renewed every two years. License agrees to update mandated reporter certificate by the end of this week. Spouse/Assistant records were reviewed and current with pediatric CPR and First Aid certification expiring 4/10/23 and Mandated Reported certificate expiring on 4/22/23. Licensee is reminded to renew certifications and training prior to expirations. The Licensee informed LPA no firearms or ammunition are stored on site.

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: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
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: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 406216030
VISIT DATE: 11/07/2022
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During today’s inspection, no deficiency observed.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Rocio Lopez- Cazares in Spanish due to Spanish being Licensee’s primary language.

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

DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
LIC809 (FAS) - (06/04)
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