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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216443
Report Date: 11/01/2022
Date Signed: 11/01/2022 11:35:50 AM

Document Has Been Signed on 11/01/2022 11:35 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:FLORES FAMILY CHILD CAREFACILITY NUMBER:
406216443
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Graciela Flores RomeroTIME COMPLETED:
11:45 AM
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On 11/1/22, at 9:15 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an announced Prelicensing Inspection of the abovementioned residence and met with Applicant Graciela Flores Romero, herein Applicant. LPA informed Applicant of the nature and purpose of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 7:00 AM to 6:00 PM, Monday- Friday. The Applicant also Informed LPA of the intention to provide care for children 0 months to 12 years of age. LPA notes one child is present at the time of the inspection.

LPA toured the interior and exterior of the residence with the Applicant. The residence is a three bedroom, and two bathroom mobile home. The home's living room, guest room, kitchen, bathroom and carport patio will be used for child care services, while the home's remaining bedrooms (Master and Children bedrooms) will be excluded from child care. LPA observed the living room to have spacing and ventilation for children in care. The residence has no fireplace is observed on site and bathroom to be used for care is observed to be clean and free of toxins. All medication in the home is stored in an elevated cabinet in the kitchen area. LPA observed cleaning compounds in the home stored in a secured cabinet underneath the sink in the kitchen and in an elevated cabinet in the hallway. LPA also observed sharps located in an elevated cabinet in the kitchen which is inaccessible and beyond the reach of children. LPA observed a required fire extinguisher (2A10BC) in the home which was service on 4/26/22. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has smoke and carbon monoxide detectors which were tested at 9:45 AM and found to be operable.

Applicant informed LPA of the intention to use the home carport for outdoor activities. The carport will have a gated enclosure and age appropriate toys and furnishings. LPA reminded Applicant to ensure the children in care are afforded direct supervision while outside of the home and children do not play outside the carport enclosure. LPA notes there is an enclosed community swimming pool in the mobile home park. Applicant informed LPA the community pool will not be used by children in care.
(CONT. LIC 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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 3
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 406216443
VISIT DATE: 11/01/2022
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LPA's record review revealed Applicant completed Preventative Health training on 9/22/22. Further, Applicant completed Mandated Reporter training on 8/26/22 and Pediatric CPR/First Aid (EMSA approved) on 9/3/22. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (Lease Agreement). Applicant does have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). LPA notes a small dog is in the home. The vaccination records for the dog was reviewed and found to be current. LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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

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 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

(CONT. LIC 809-C)

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

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 406216443
VISIT DATE: 11/01/2022
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To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant Graciela Flores Romero. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 11/1/22.

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

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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