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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208696
Report Date: 09/09/2022
Date Signed: 09/09/2022 04:16:40 PM

Document Has Been Signed on 09/09/2022 04:16 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:NAVARRO FAMILY CHILD CAREFACILITY NUMBER:
426208696
ADMINISTRATOR:MARIA NAVARROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 345-1927
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Maria NavarroTIME COMPLETED:
04:30 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 9/9/2022, at 12:00 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection. LPA met with Maria Navarro, Licensee. The licensee stated the assistant Columba Martinez Antonio, just left the FCCH. The licensee called the assistant to return to the FCCH.

At 12:13 PM, the assistant arrived to the FCCH. LPA asked the assistant if she had worked at the FCCH today? The assistant stated "yes, I arrived at 7:30 AM and left at 10:30 AM.

The purpose of the visit was discussed with the Licensee and together we toured the inside and outside of the home. LPA observed 5 children napping the bedroom #1, infant #1 was in an infant rocker with 2 blankets and infant #2 was napping in a pack N play with blankets, items attached, raised liner, and hanging toys attached to the pack N play at the time of the inspection.

The main day care areas are living room, dining room, kitchen, bedroom #1 and hallway bathroom. LPA observed in the children's bathroom Lysol spray, hair shampoo, and hair conditioner accessible to children in care. LPA observed in the kitchen and outside patio tables where the children eat and have snack the following items: disinfecting spray, disinfecting wipes, and Lysol spray accessible to children in care.

LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include the 2 bedrooms and garage secured with doorknob covers and locks on the doors. The backyard is completely fenced. No bodies of water were observed at the time of the inspection. This report continues on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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: NAVARRO FAMILY CHILD CARE
FACILITY NUMBER: 426208696
VISIT DATE: 09/09/2022
NARRATIVE
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Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. LPA reviewed the facility roster. The licensee stated there is no fire extinguisher in the FCCH. Per licensee the carbon monoxide detector and smoke alarm that were last tested on 7/9/2022. Licensee and assistant are current with immunization required per SB 792. The last Safety drill was not available at the time of the inspection. Licensee is current with CPR and First Aid which expires July 24, 2024.

Licensee is not providing Incidental Medical Services. 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: htttp://www.ada.gov/childqanda.htm

Licensee has completed the Mandated Reporter Training required per AB 1207, the certificate was not available at the time of the inspection.

LPA reviewed with Licensee the Safe Sleep Regulation (PIN 20-24-CCP-SP), The Effects of Lead, and What is Carbon Monoxide. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov. Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

Today’s visit was conducted in Spanish by LPA Jimenez. Today, deficiency cited under Title 22 Division 12 , Spanish appeal rights given.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 09/09/2022 04:16 PM - It Cannot Be Edited


Created By: Martina Jimenez On 09/09/2022 at 03:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NAVARRO FAMILY CHILD CARE
FACILITY NUMBER: 426208696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation of the children's bathroom, kitchen and outside patio tables, LPA observed Lysol spray, hair shampoo, hair conditioner disinfecting spray, disinfecting wipes, and Lysol spray accessible to children in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2022
Plan of Correction
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Licensee will submit photos of corrections to CCLD, via email by 9/12/2022, to: Martina.Jimenez@dss.ca.gov
Type A
Section Cited
CCR
102416.5(b)(2)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observed 5 children napping the bedroom #1, infant #1 was in an infant rocker and infant #2 was napping in a pack N play in the living room, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2022
Plan of Correction
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Licensee will submit a written statement to CCLD on how licensee will prevent future incidents by 9/12/2022, via email: Martina.Jimenez@dss.ca.gov
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 Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 09/09/2022 04:16 PM - It Cannot Be Edited


Created By: Martina Jimenez On 09/09/2022 at 03:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NAVARRO FAMILY CHILD CARE
FACILITY NUMBER: 426208696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observed infant #1 was in an infant rocker with 2 blankets and infant #2 was napping in a pack N play with 2 blankets, items attached, raised liner, and hanging toys attached to the pack N play at the time of the inspection.


which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2022
Plan of Correction
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Licensee will submit a written statement to CCLD on how licensee will prevent future incidents by 9/12/2022, via email: Martina.Jimenez@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 09/09/2022 04:16 PM - It Cannot Be Edited


Created By: Martina Jimenez On 09/09/2022 at 03:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NAVARRO FAMILY CHILD CARE
FACILITY NUMBER: 426208696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee stated there is no fire extinguisher in the FCCH, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2022
Plan of Correction
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Licensee will submit verification of receipt for the purchase/service of the fire extinguisher , to CCLD by 9/16/2022, via email: Martina.Jimenez@dss.ca.gov
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the licensee stated the last Safety drill was not available at the time of the inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2022
Plan of Correction
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Licensee will submit verification of fire drill conducted, to CCLD by 9/16/2022, via email: Martina.Jimenez@dss.ca.gov
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 Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 09/09/2022 04:16 PM - It Cannot Be Edited


Created By: Martina Jimenez On 09/09/2022 at 03:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NAVARRO FAMILY CHILD CARE
FACILITY NUMBER: 426208696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee stated has completed the Mandated Reporter Training required per AB 1207, but certificate was not available at the time of the inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2022
Plan of Correction
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Licensee will submit verification of Mandated Reporter training certificate, to CCLD by 9/16/ 2022, via email: Martina.Jimenez@dss.ca.gov
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee stated that licensee does not have files for the two (2) infants in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2022
Plan of Correction
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Licensee will submit verification of infant#1 & infant#2 complete files, to CCLD by 9/16/ 2022, via email: Martina.Jimenez@dss.ca.gov
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 Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 09/09/2022 04:16 PM - It Cannot Be Edited


Created By: Martina Jimenez On 09/09/2022 at 03:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NAVARRO FAMILY CHILD CARE
FACILITY NUMBER: 426208696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on licensee stated that licensee does not have infant safe sleep plans for the two (2) children in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2022
Plan of Correction
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2
3
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Licensee will submit verification of infant#1 & infant#2 safe sleep plans, to CCLD by 9/16/ 2022, via email: Martina.Jimenez@dss.ca.gov
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee stated that licensee does not have infant time of each 15-minute check documentation for the two (2) children in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/16/2022
Plan of Correction
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2
3
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Licensee will submit verification of infant#1 & infant#2 safe sleep charts, to CCLD by 9/16/ 2022, via email: Martina.Jimenez@dss.ca.gov
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 Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


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