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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216053
Report Date: 09/13/2021
Date Signed: 09/13/2021 04:31:01 PM

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:AGUILAR FAMILY CHILD CAREFACILITY NUMBER:
406216053
ADMINISTRATOR:AGUEDA AGUILARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 975-9457
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:14CENSUS: 6DATE:
09/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Agueda AguilarTIME COMPLETED:
04:35 PM
NARRATIVE
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On 9/13/2021 at 2:02pm, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 via phone with Licensee, Agueda Aguilar. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. LPA observed the required documents posted inside of the home on the wall adjacent to the front door. There were six (6) day care children present, including a seven (7) month old infant, child #1 (C1) who was asleep in a car seat. Licensee removed C1 from the car seat at approximately 2:05pm. LPA explained that infants under 12 months of age are not permitted to sleep in car seats and that they must be placed on their backs in a portable crib. Licensee stated that she was not aware that infants cannot sleep in a car seat and that C1 has trouble falling asleep on flat surfaces. Licensee's 10 year old and 12 year old children were also present.

LPA provided Licensee with a copy of the current California Department of Public Health guidance dated 7/29/21 which requires persons over the age of two (2) years to wear face coverings when indoors of child care settings. Licensee stated that children over the age of 2 years are encouraged to wear face coverings while indoors. Child care services are provided in the the living room and dining room. LPA observed age appropriate toys, cots for rest time and child sized tables and chairs. The bathroom used by children was observed to be clean and free of toxins. Licensee stated that the master bedroom with ensuite bathroom and two (2) additional bedrooms are off limits, but were not locked.

Licensee stated there are no guns or ammunition in the home. Detergents, cleaning compounds, medications and other items such as kitchen knives which could pose a danger to children are stored inaccessible to children. Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021
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 5
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: AGUILAR FAMILY CHILD CARE
FACILITY NUMBER: 406216053
VISIT DATE: 09/13/2021
NARRATIVE
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Smoke and Carbon monoxide detector was tested at 2:10pm and found to be operational. LPA observed the 2 A10 BC fire extinguisher with a service date of 6/14/2021. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee completes and documents emergency drills. The most recent drill was held on 5/12/21.

LPA observed the outdoor activity area which is accessed through the sliding glass door in the dining room. Licensee stated that the children are not using the backyard for activities at this time. LPA observed a children's happy birthday sign on the fence, empty glass bottles in a pile on the side of the backyard by the fence and a trampoline with a netting that was not zipped closed. The gate which encloses the backyard was wide open. Licensee reported that the family had celebrated her child's birthday on 9/11/2021 and that she has not finished cleaning up the backyard yet. Licensee also stated that the trampoline is not used by day care children and will be kept zipped and locked when children are outside.

Licensee's Pediatric CPR and first aid expired on 8/30/2021. Licensee reported that she has an appointment scheduled for 9/15/2021 at 6pm with trainer to update the certification for Licensee and spouse. Licensee has met SB 792 immunization requirement and completed Mandated Reporter Training per AB 1207 in November 2020 when she moved to the new location, but could not located the certificate of completion. Licensee stated that she will send LPA a copy of the certificate or re-take the training and email a copy to LPA on or before 9/30/2021. Facility roster was not updated with current children enrolled. A sample of children's records were reviewed for Identification and Emergency information (LIC 700) and found complete. LPA observed that Licensee is conducting and recording 15 minute checks of all children under the age of two (2) years on a sleep log.



Infant Safe Sleep Regulation section 102425 was discussed. LPA provided PIN 20-24-CCP and Individual Infant Sleep Plan (LIC9227) in English and Spanish. LPA provided the “Effects of Lead Exposure” brochure in Spanish (PUB515SP) to be distributed to all families at time of enrollment. LPA advised Licensee that Title 22, Division 12 regulations for Family Child Care Homes and California Department of Public Health COVID-19 guidelines for .... Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: AGUILAR FAMILY CHILD CARE
FACILITY NUMBER: 406216053
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2021
Section Cited

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102425 Infant Safe Sleep (h) Car seats shall only be used for transportation purposes and shall not be used for sleeping.
This requirement is not met as evidenced by:
LPA observed C1 asleep in a car seat which poses an immediate risk to the health and or safety of children in care.
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LPA including a record of what was learned regarding Safe Sleep of infants in care Please submit via email or text photo to LPA Stewart on or before 9/30/2021.

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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 MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: AGUILAR FAMILY CHILD CARE
FACILITY NUMBER: 406216053
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited

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102417 Operation of a Family Child Care Home (8)(A)...Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include...daytime telephone number of the child's parent or guardian... This roster shall be available to the licensing agency upon request.
This requirement is not met as evidenced by:
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Based on interview and record review, the children present today were not listed on the facility roster (LIC9040) which poses a potential risk to the health and/or safety of children 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 MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: AGUILAR FAMILY CHILD CARE
FACILITY NUMBER: 406216053
VISIT DATE: 09/13/2021
NARRATIVE
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child care programs can be accessed on-line at www.cdss.ca.gov. COVID19 Information for San Luis Obispo County can be found at www.emergencyslo.org/en/covid19.aspx. Licensee stated that she is subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that there are no children enrolled who require medications at this time. 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



Type A and Type B deficiencies cited today in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee, Agueda Aguilar, whose signature on this form confirm receipt of these documents.
Upon receipt, provide copies of this licensing report to each parent/guardian of enrolled children and to parents/guardians of newly enrolled children during the next 12 months. Acknowledgement of Receipt LIC 9224 form shall be used for this purpose. LIC 9224 after completed shall be maintained in each child's file. (LIC 9224 was provided to Licensee).

LPA provided a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5