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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212780
Report Date: 09/27/2021
Date Signed: 09/28/2021 08:14:01 AM

Document Has Been Signed on 09/28/2021 08:14 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:LEON FAMILY CHILD CAREFACILITY NUMBER:
426212780
ADMINISTRATOR:BEATRIZ LEONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 717-4019
CITY:BUELLTONSTATE: CAZIP CODE:
93427
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Beatriz LeonTIME COMPLETED:
01:40 PM
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On 9/27/2021, Licensing Program Analyst Gigi Reyes conducted an unannounced Required Annual Inspection, met with Licensee and discussed the purpose of the inspection. Prior to inspection, LPA asked pre health screening questions related to COVID 19, Licensee's responses indicate there are no COVID 19 exposure in the Family Child Care Home (FCCH).

LPA and Licensee toured the interior and exterior of the home, there were 6 children present one being an infant . During the tour LPA observed the following, required forms are posted in the prominent location. Appropriate fire extinguisher was purchased on 9/12/2021. Smoke and carbon monoxide detectors were tested and found functional. Toxins are locked. LPA observed age appropriate toys and play equipment.

The backyard is completely fenced. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home.

LPA reviewed the following documents, Pediatric CPR and First Aid Card expires on 6/21/2023. Licensee and staff have record of immunization as required by SB 792. Licensee and staff have not taken the Mandated Reporter Training per AB 1207. Fire and Disaster drill is conducted and logged every month. Last drill was conducted on 9/8/2021. Children’s roster is current.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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: LEON FAMILY CHILD CARE
FACILITY NUMBER: 426212780
VISIT DATE: 09/27/2021
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LPA reviewed children records. There are emergency contact Information on file, however, LPA observed that children's immunization are not recorded and updated in the blue immunization card CDPH or PM 286 card.

LPA discussed Safe Sleep Regulations with Licensee. Providers must check on sleeping infants (0 to 24 months) every 15 minutes and document their condition to check for signs of distress, which includes, but is not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness. Each infant, up to 12 months of age, must have an Individual Infant Sleeping Plan (LIC 9227) on file, which will document the infant's sleeping habits, usual sleep environment, and the infant's rolling abilities.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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: www.ada.gov/childqanda.htm

Licensee was reminded that it is her responsibility to know the regulations for FCCH which can be accessed on-line at www.ccld.ca.gov.

During the inspection, deficiencies were cited under Title 22 division 12 and Health and Safety Code. Appeal Rights were provided and explained.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/28/2021 08:14 AM - It Cannot Be Edited


Created By: Gigi Reyes On 09/27/2021 at 12:27 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: LEON FAMILY CHILD CARE
FACILITY NUMBER: 426212780

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2021
Section Cited
HSC
1596.8662

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training... every two years... This requirement is not met as evidenced by:
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Licensee and assistant agreed to take the Mandated Reporter Training (AB 1207) and submit the proof to CCLD no later than October 11, 2021.
gigi.reyes@dss.ca.gov
LPA provided the link mandatedreporter.ca.com
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During inspection, Licensee stated that she and staff have not taken the Mandated Reporter Training. This poses a potential risk to health and safety of children in care.
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Type B
10/15/2021
Section Cited
CCR102418(g)(1)

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Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070..
(1) This requirement includes updating each child's PM 286 (6/95).
This requirement is not met as evidenced by:
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Licensee agreed to update the blue immunization card (PM 286) and submit proof no later than 10/15/2021.

gigi.reyes@dss.ca.gov
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During children's file review, it was observed that children's immunization are not updated in CDPH/PM 286, Child 1(C1), C2, C3, C4, and C5.
This poses a potential risk to health and safety of children in care.
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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:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2021


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