406216412-9-21-2022-17-CC-FPEA-CJGPB5-20220921110946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406216412
Report Date: 09/21/2022
Date Signed: 09/21/2022 11:09:55 AM

Document Has Been Signed on 09/21/2022 11:09 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:	MADRIGAL FCC AKA TINY TOWN		FACILITY NUMBER:	406216412
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	09/21/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Amanda Madrigal		TIME COMPLETED:	11:24 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 21, 2022 at 9:15 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an announced Prelicensing inspection. LPA met with Applicant Amanda Madrigal and advised her the purpose of the inspection. Applicant provided LPA a tour of the home inside and out. There were no children in care at the the time of inspection. Applicant has a one story home with a loft. Facility has a three (3) bedroom home. Children will have access to the living room, one (1) bathroom, kitchen, and front yard. The master bedroom, two (2) bedrooms, and backyard will be off-limits to children. LPA observed a gate in the hallway preventing children from accessing the one bedroom, master bedroom, and backyard. LPA informed applicant to ensure the gate is secured at all times and the applicant advised they understood. Applicant advised that the doors to the rooms lock and will be secured preventing children from having access. LPA observed a fire place in the living room with a secured screen. LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher with a service date of 9/20/2022 was observed mounted on the wall. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA observed the home has functioning smoke and carbon monoxide detectors. There are age appropriate toys and day-care equipment in the home. Applicant plans to only provide care for preschool children half day with no infants. Applicant will be using the front yard for children to play. Applicant has a fence they are using to prevent children from leaving the front yard. LPA observed sufficient shade for children to have access to. LPA spoke with applicant about supervision and accountability. LPA advised applicant must provide visual supervision while the children are playing outside in the front yard. Applicant would like to use their garage for activities and learning. Per applicant children will not be eating or sleeping in the garage. LPA advised that the facility would have to get approval from the local fire department. Continued on 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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: MADRIGAL FCC AKA TINY TOWN	FACILITY NUMBER: 406216412
	VISIT DATE: 09/21/2022

NARRATIVE

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Until a written approval from the local fire department is acquired, no care or activities will be allowed. LPA advised if approval is granted, licensing will have to inspect the garage to approve the area for care at a later date.

Preventative Health & Safety and Nutrition Training completed on 9/1/2022. Applicant First Aid/CPR certificates is valid until 8/8/24. Applicant AB 1207 Mandated Reporter Training Certificate expires 8/31/24. Applicant stated they do not have firearms and ammunition in the home. Applicant provided proof of control of property. LPA discussed and verify SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). Applicant was informed walkers, bouncers and any similar object that restricts children's movement is prohibited from licensed facilities.

LPA reviewed, discussed and gave applicant updated samples of state required forms to be kept in the children's file, required forms to be posted and forms that needs to be maintained at the Family Child Care Home (FCCH). Applicant was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov.

Applicant 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, 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 applicant 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 [applicant, licensee, or 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.

Continued on 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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: MADRIGAL FCC AKA TINY TOWN	FACILITY NUMBER: 406216412
	VISIT DATE: 09/21/2022

NARRATIVE

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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 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

No deficiencies observed during this inspection.

License to operate a Family Child Care facility is effective today September 21, 2022 for eight (8) children.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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