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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406217121
Report Date: 08/15/2024
Date Signed: 08/16/2024 02:22:16 PM

Document Has Been Signed on 08/16/2024 02:22 PM - 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:NUNEZ FAMILY CHILD CAREFACILITY NUMBER:
406217121
ADMINISTRATOR/
DIRECTOR:		NUNEZ, MARGARITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 909-1601
CITY:CAMBRIASTATE: CAZIP CODE:
93428
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/15/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:18 AM
MET WITH:Margarita Nunez and Martin RenteriaTIME VISIT/
INSPECTION COMPLETED:
01:08 PM
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This is a change of location; previous License no. was.406215055

On August 15, 2024, at 10:18 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced pre-licensing inspection at the above Family Child Care Home (FCCH). LPA met with the applicant, Margarita Nunez and husband, Martin Renteria. and discussed the purpose of the inspection. Applicant's 2 grandchildren were also present.

Applicant, her husband and LPA toured the home. This is a one story home consisting of 3 bedrooms, 2 baths, living room, kitchen, dining, garage, fenced deck and fenced side yard. Areas accessible to children will be the living room, hallway by the entrance door and 1 bathroom. Off limit areas are 3 bedrooms, 1 bath, dining and kitchen areas, deck and the side yard. Off limit areas are securely barricades to ensure no child enters the restricted areas. The applicant stated that for outdoor activities, they plan to take children for walks to the near by park and the campground located close to the home.

It was noted that knives and cleaning materials are kept inaccessible to children in care. The bathroom for children’s use is free of toxins during the time of the inspection. The 2A10 BC fire extinguisher was serviced on 4/29/2024. Applicant installed multiple carbon monoxide and smoke detectors in every room as required by the fire inspector

Continued LIC 809 C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 406217121
VISIT DATE: 08/15/2024
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 US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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.LPA discussed the safe sleep regulations with applicant, and discussed the Child Care Licensing Safe Sleep webpage at: htttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource.

Control of Property was reviewed, the Grant Deed is under the name of applicant's daughter and husband, Karely and Luis Alberto Lizaloa who both live in the home. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant, has obtained a signed Property Owner/Landlord Consent form (LIC9149).



A notice of site visit was given to applicant, and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant, Margarita Nunez. Report was translated in Spanish by applicant's husband, Mr. Martin Renteria

The Large Family Child Care License (FCCH) is pending until the following are completed/submitted:
1. Installation of pull alarm
2. Preventative Health and Safety and Nutrition certificate
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 406217121
VISIT DATE: 08/15/2024
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Carbon monoxide and smoke detectors were tested and found to be functional. Cambria Fire Department granted the fire clearance on 8/14/2024, however, LPA did not observe a pull alarm. The applicant stated that there are no guns and ammunition in the home. LPA did not observe any bodies of water.

Applicant completed the Family Child Care orientation on 5/20/2015. LPA did not observe Preventative Health and Safety and Nutrition certificate on file. Pediatric 1st Aid/CPR training was completed on 6/16/2023 (expires on 6/16/2025), while the Mandated Reporter Training was completed on 6/27/2024 (expires on 6/27/2026). Applicant was reminded that AB 1207 and Pediatric CPR should be renewed every 2 years. The applicant stated that FCCH does not carry a liability insurance. LPA explained that each parent of a child in care is required to sign an affidavit (LIC 282) acknowledging this . The signed affidavit must be kept in the child's file.

LPA discussed the requirement for care providers/employees, including volunteers, to obtain immunization against Influenza, Pertussis, Measles, including verification of TB, with applicant's verification being on file.

Prohibited items and equipment in the FCCH, such as walkers, bouncers, etc., were also reviewed with the applicant, as well as 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. Children's record-keeping requirements were also reviewed.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided:

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC809 (FAS) - (06/04)
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