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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212955
Report Date: 09/26/2024
Date Signed: 09/26/2024 11:04:53 AM

Document Has Been Signed on 09/26/2024 11:04 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LOZANO FAMILY CHILD CAREFACILITY NUMBER:
426212955
ADMINISTRATOR/
DIRECTOR:		YIDA LOZANOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 681-1063
CITY:SANTA BARBARASTATE: CAZIP CODE:
93110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
09/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Yida LozanoTIME VISIT/
INSPECTION COMPLETED:
11:19 AM
NARRATIVE
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On September 26, 2024 at 9 AM, Licensing Program Analyst (LPA) Susana Martinez made an unannounced visit for the purpose of conducting a Case Management- incident inspection. LPA met with Yida Lozano, Licensee, to discuss an incident that was self reported to Community Care Licensing Division (CCLD) office by phone on 09/13/2024. LPA was given a tour of the facility, at the time of inspection there were 12 children in care of Licensee and (2) two assistants who are associated to the facility.

LPA toured the area where the incident occurred and interviewed Licensee.

On Thursday, 09/12/2024 an incident occurred at the family child care home at or around 9:30 AM.
A child (C1) was sitting in the infant area rug playing with a push walker when a 3 year old child (C2) walked over and tripped on C1. As C2 tripped, C1 hit themselves on the push walker causing a laceration to the forehead. C1 was taken to the doctor and received stitches.

Licensee observed the incident as she was on the rug in the infant area in close proximity to C1. Licensee states she advised C2 to be careful, and then the incident occurred. C1 was playing with a push walker, an item not permitted in the facility. Parents of C1 were contacted right after the incident occurred, C1's parent arrived to the facility and took C1 to seek medical attention. The child (C1) returned to the facility the following week on Tuesday, 09/17/2024 without any restrictions.

To prevent any similar incidents, the Licensee plans to prevent children from accessing the infant rug and reminding older children to be cautious of the younger children. Licensee will also be removing two infant push walkers and a saucer from the home.

LPA determined that the incident was true and did occur. Given the facility's account of the incident when reporting it to CCLD and how they addressed the incident, LPA deemed the facility's action was appropriate. One type B deficiency was issued during today's inspection for having items not permitted in facilities.

Continued on 809-D
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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Document Has Been Signed on 09/26/2024 11:04 AM - It Cannot Be Edited


Created By: Susana Martinez On 09/26/2024 at 10:08 AM
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: LOZANO FAMILY CHILD CARE
FACILITY NUMBER: 426212955

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2024
Section Cited
CCR
102417(d)(1)

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Operation of a Family Child Care Home 102417(d)The home shall provide safe toys, play equipment and materials.(1) Fixtures, furniture and equipment that have been banned...shall not be used for children in care or accessible to children in care. This requirement was not met as evidence by:
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The Licensee agrees to remove prohibitted items from the facility.
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Based on observation and interview, the licensee has items not allowed in the home (push walkers and saucers) which poses a potential) Health and/or, Safety and, Personal Rights risk to persons 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:Ana Tolentino
LICENSING EVALUATOR NAME:Susana Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2024


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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LOZANO FAMILY CHILD CARE
FACILITY NUMBER: 426212955
VISIT DATE: 09/26/2024
NARRATIVE
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During the inspection, LPA observed a water fountain at the entrance of the home. Licensee states children do not go in the front yard, but occasionally may touch the water when entering or exiting the home. Licensee states she talks to children about not touching the fountain because the water is dirty. LPA recommended for Licensee to drain the water to prevent children from having contact. A technical violation was issued for this matter.

During the inspection, LPA also observed three (3) sleep sacks placed in each of the three (3) cribs located in the living room. LPA advised Licensee that sleep sacks are not permitted in the home and are only allowed on a case by case situation when an exception is submitted to the Department for review. LPA also provided a technical violation for this matter.

During today's inspection a Type B deficiency was issued and can be found on the attached 809-D.

LPA provided the following resources to the Licensee:

- Pictorial handout of items not permitted in the facility.

- Safe Sleep Frequently Asked Questions in Spanish.

- LIC811 (Confidential names).

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

Exit interview conducted, appeal rights were given and report was reviewed with Licensee, Yida Lozano.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
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