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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426209361
Report Date: 04/03/2023
Date Signed: 04/03/2023 03:58:53 PM

Document Has Been Signed on 04/03/2023 03:58 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:PULIDO FAMILY CHILD CAREFACILITY NUMBER:
426209361
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
04/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Irene PulidoTIME COMPLETED:
04:00 PM
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On April 13. 2023 at 2:50 PM, Licensing Program Analysts Gigi Reyes and Dixie Wright conducted an unannounced Required 1 Year inspection. LPA asked pre screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID 19 exposures on site. LPA met with licensee, Irene Pulido and discussed the purpose of the inspection. During the inspection licensee was caring for two children.

LPA in the company of Licensee toured the interior and exterior of the day care. Family Child Care Home (FCCH) uses the living room, dining room, backyard, bathroom and the garage for other activities. LPA observed required licensing forms are posted in the by the entry door. LPA observed smoke and carbon monoxide detectors in the FCCH. The regulation fire extinguisher was purchased on 4/5/2022. LPA Reyes notified Licensee to service or purchase a new extinguisher. The play yard is enclosed by wooden fence. LPA observed age appropriate toys. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home.

LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires 10/12/2023. Licensee has taken the Mandated Reporter Training per AB 1207, expires 04/18/2024. Last fire drill was done 10/17/2022. Licensee has proof of immunization on file. FCCH conducts fire and disaster drill every six months. FCCH has current roster of children in care. A sampling of children records was reviewed and found to be current. File contains Emergency and Identification card requirements. Licensee carries liability insurance for Day Care business.

During today's inspection, no deficiencies were cited.
Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
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: PULIDO FAMILY CHILD CARE
FACILITY NUMBER: 426209361
VISIT DATE: 04/03/2023
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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 Home 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the website www.cdss.ca.gov/inforesources/community-care-licensing/process.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

A notice of site visit was given and must remain posted for 30 days. Report was reviewed and exit interview was conducted with Licensee, Irene Pulido.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
LIC809 (FAS) - (06/04)
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