<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216500
Report Date: 12/19/2022
Date Signed: 12/19/2022 11:25:36 AM

Document Has Been Signed on 12/19/2022 11:25 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:SJOGREN FAMILY CHILD CAREFACILITY NUMBER:
406216500
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amorita SjogenTIME COMPLETED:
10:28 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
Previous Facility #406216361
On 12/19/22, at 9:30 AM, Licensing Program Analysts (LPAs) Elvin Baddley and Francisca Velazquez conducted an announced Prelicensing/ Change of Location Inspection of the abovementioned residence and met with Licensee Amorita Sjogren. LPAs informed Licensee of the nature and purpose of the inspection. Licensee informed LPAs of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 7:30 AM to 5:30 PM, Monday- Friday. The Licensee also Informed LPAs of the intention to provide care for children 0 months to 12 years of age. LPAs note no children are in care at the time of the inspection.

LPAs toured the interior and exterior of the residence with the Licensee. The residence is a three bedroom, two bathroom single story dwelling. The home's living room, dinning room, hallway bathroom, office/guest bedroom and backyard will be used for child care services, while the remainder of the home is excluded.

LPAs observed the home to have spacing and ventilation for children in care. The home's fireplace is screened by a metal mesh screen. The bathroom to be used for children care is observed to be clean and free of toxins. Medication, cleaning compounds and sharps in the home are in elevated, secure cabinet which are inaccessible to children in care.

LPAs observed a required fire extinguisher (2A10BC) in the home which was service on 8/26/22. LPA reminded Licensee of the responsibility to service or purchase a regulation fire extinguisher annually. The home has numerous combination smoke and carbon monoxide detectors. A combination smoke and carbon monoxide detector was tested in the kitchen area at 10:25 AM and found to be operable.

The backyard is enclosed by wooden fencing and the footing is varied. LPAs observed a wooden deck and an entry/ exit gate to the area which is secure. The backyard is petitioned to create a run area which is inaccessible to children in care.
(CONT LIC 809-C, Page 1)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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: SJOGREN FAMILY CHILD CARE
FACILITY NUMBER: 406216500
VISIT DATE: 12/19/2022
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
26
27
28
29
30
31
32
LPAs reminded Licensee to ensure the children in care are afforded direct supervision while children are engaged in activities in the backyard. LPAs observed no bodies of water on site.

LPAs' record review revealed Licensee completed Preventative Health training on 6/24/22. Further, Licensee completed Mandated Reporter training on 7/8/22 (expiration 7/8/24) and Pediatric CPR/First Aid (EMSA approved) on 8/14/22 (expiration 8/14/24). LPAs reminded Licensee of obligation to maintain current training and certifications. LPA reviewed Licensee's control of property documents. Licensee does have liability insurance for the home. Licensee informed no firearm or ammunition are on site.

LPA reviewed with Licensee 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



Licensee 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.

LPAs 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 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.

(CONT. 809-C, Page 3)

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

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC809 (FAS) - (06/04)
Page: 2 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: SJOGREN FAMILY CHILD CARE
FACILITY NUMBER: 406216500
VISIT DATE: 12/19/2022
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
26
27
28
29
30
31
32
Exit interview conducted and report was reviewed with the Licensee Amorita Sjogren. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 12/19/22.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3