426210323-9-27-2023-17-CC-GGOZ-CW3TH4-20230927144407

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426210323
Report Date: 09/27/2023
Date Signed: 09/27/2023 02:44:13 PM

Document Has Been Signed on 09/27/2023 02:44 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CHAVEZ FAMILY CHILD CARE		FACILITY NUMBER:	426210323
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	09/27/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Margarita Rojas		TIME COMPLETED:	03:15 PM

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	On September 27, 2023 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Annual/Random inspection at the above-mentioned FCCH. LPA met with Licensee and informed them of the the purpose of the inspection. LPA, in the company of the Licensee toured the interior and exterior of the FCCH. The home's family room, one bathroom and backyard for child care purposed. At the time of the inspection there were no children in care. LPA observed age appropriate toys, furniture and equipment in the FCCH's interior. LPA observed a counter with a sink and refrigerator in the family room that was blocked off by a child safe gate. LPA observed the bathroom that is used for child care to to be clean and free of toxins. Licensee notified LPA that they close the family room door when children are present in order to make the remainder of the home inaccessible. LPA observed cleaning compounds to be stored under the sink in the FCCH's kitchen which is made inaccessible by a child safe lock. Sharps are stored in a kitchen drawer which is made inaccessible to children by a child safe lock. Medication is stored in an elevated cabinet in the kitchen beyond the reach of children. LPA observed required licensing forms and documents to be prominently posted in the FCCH's family room. LPA observed multiple a combination smoke and carbon monoxide detectors in the FCCH. A combination were tested at 12:14PM and found to be operable. The FCCH has a regulation fire extinguisher (2A10BC) which was serviced 6/28/23. LPA reminded Licensee to either service or purchase a regulation fire extinguisher annually. The backyard is enclosed by a wooden fencing and the footing of the area is cement. LPA observed the backyard to be clean and free of hazards. The entry and exit ways were observed to have the ability to be secured. LPA observed no bodies of water on site. The Licensee has two dogs with current vaccination CONTINUED PAGE 2

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 426210323
	VISIT DATE: 09/27/2023

NARRATIVE

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records. The dogs are in a separate part of the backyard that is enclosed by a fence.

During this inspection children's files were not reviewed since the Licensee has been inactive for more than 3 years and have not begun to enroll children. LPA reminds Licensee that it is their responsibility to have complete and current documents in the children's files when they begin enrolling children. The Licensee's records were reviewed and found to be current. Licensee's Pediatric CPR and First Aid expires on 5/18/2025. Licensee's Mandated Reporter Training (AB1207 compliant) expires on 6/27/2025 . LPA reminded Licensee that it is their responsibility to maintain current certifications and training.

LPA 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 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.

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: 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee , confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

CONTINUED PAGE 3

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 426210323
	VISIT DATE: 09/27/2023

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Margarita Chavez.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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