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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213623
Report Date: 11/30/2022
Date Signed: 11/30/2022 06:14:57 PM

Document Has Been Signed on 11/30/2022 06:14 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:VASQUEZ FAMILY CHILD CAREFACILITY NUMBER:
426213623
ADMINISTRATOR:VIRGINIA VASQUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 714-7001
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 5DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Virginia VasquezTIME COMPLETED:
06:30 PM
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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 11/30/2022, at 1:45 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection. LPA met with Virginia Vasquez, Licensee, and Estela Almaguer, Assistant. The purpose of the visit was discussed with the Licensee and together we toured the inside and outside of the home. LPA observed 4 children and 1 infant in care at the time of the inspection.

The main day care areas are family room, dining room, kitchen, and bathroom. LPA observed upon arrival three men working on the floors to the FCCH, and the remodeling of the children's bathroom, during day-care hours. LPA observed the licensee in the kitchen/dining room area with an infant and a toddler, who was napping at the time of the inspection. LPA observed the assistant outside with three (3) children playing in the children's play area.

LPA observed the furniture, cubbies, toys, tables and chairs in the center of the

THIS REPORT CONTINUES ON LIC 809C & LIC 809D
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213623
VISIT DATE: 11/30/2022
NARRATIVE
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family room. The children's bathroom is gutted with only the tub. LPA observed a man texturing the bathroom walls at the time of the inspection.

LPA observed a man in the family room installing flooring in the family room and a third man in the master bedroom also installing flooring at the time of the inspection, prior to submitting a plan notifying CCLD. LPA observed an electrical cord, a hammer, an axe, and a floor cutting tool on the floor of the hallway.

Licensee stated the children are using the bathroom in the master bedroom. LPA observed in the master bathroom, hair spray, Milk of magnesium, and personal hygiene items accessible to children in care. The licensee stated that she walks the children to and from the master bathroom when the children's need to use the bathroom.

LPA observed age appropriate books, toy, games, tables and chairs. The backyard is completely fenced. No bodies of water were observed.

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. LPA review child #1's file which revealed no safe sleep plan, no sleep chart, and no immunization in child's #1 file. The fire extinguisher was observed and was serviced June 23, 2022. There is a functioning carbon monoxide detector and smoke alarm that were tested at 3:36 pm, in the home, that meets statutory
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
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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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213623
VISIT DATE: 11/30/2022
NARRATIVE
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requirements. Licensee is current with immunization required per SB 792. The assistant's immunization's were not available at the time of the inspection. The last Safety drill at was conducted and documented on March 14, 2022. Licensee is current with CPR and First Aid which expires May 13, 2023. Licensee and assistant completed the Mandated Reporter Training required per AB 1207, on June 27, 2022.

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

LPA reviewed with Licensee the Safe Sleep Regulation. 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

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

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
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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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213623
VISIT DATE: 11/30/2022
NARRATIVE
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Today’s visit was conducted in Spanish. 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: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
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Document Has Been Signed on 11/30/2022 06:14 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/30/2022 at 05:16 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022

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 LPA observed an electrical cord, a hammer, an axe, and a floor cutting tool on the floor of the hallway. LPA observed in the master bathroom, hair spray, Milk of magnesium, and personal hygiene items accessible to children in care,
which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2022
Plan of Correction
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licensee will submit photos of corrections to CCLD by 12/1/2022, 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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4
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: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022


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Document Has Been Signed on 11/30/2022 06:14 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/30/2022 at 05:16 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA review child #1's file which revealed no safe sleep plan in child's #1 file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/07/2022
Plan of Correction
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Licensee will submit photo verification of safe sleep plan for child#1 to CCLD by 12/7/2022, via email: Martina.Jimenez@dss.ca.gov
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the review of files revealed the assistant's immunization's were 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: 12/07/2022
Plan of Correction
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Licensee will submit photo verification of safe sleep plan for child#1 to CCLD by 12/7/2022, 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: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022


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Document Has Been Signed on 11/30/2022 06:14 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/30/2022 at 05:16 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observed a man texturing the bathroom walls at the time of the inspection. LPA observed a man in the family room installing flooring in the family room and a third man in the master bedroom also installing flooring at the time of the inspection, to notifying CCLD of any changes to the FCCH, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/07/2022
Plan of Correction
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Licensee will submit photo verification of safe sleep plan for child#1 to CCLD by 12/7/2022, via email: Martina.Jimenez@dss.ca.gov
Section Cited
Alterations to Existing Building or Grounds
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022


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Document Has Been Signed on 11/30/2022 06:14 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/30/2022 at 05:16 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on the Estela Almaguer, assistant's immunization's were 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: 12/07/2022
Plan of Correction
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2
3
4
Licensee will submit photo of correction to CCLD by 12/7/2022, via email: Martina.Jimenez@dss.ca.gov
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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4
Based on LPA review child #1's file which revealed no safe sleep plan, in child's #1 file.

which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/07/2022
Plan of Correction
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2
3
4
Licensee will submit photo of correction to CCLD by 12/7/2022, 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: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022


LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 11/30/2022 06:14 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/30/2022 at 05:16 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213623

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
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
1
2
3
4
Based on The children's bathroom is gutted with only the tub. LPA observed a man texturing the bathroom walls at the time of the inspection. LPA observed a man in the family room installing flooring in the family room and a third man in the master bedroom also installing flooring at the time of the inspection, prior to submitting a plan notifying CCLD, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/07/2022
Plan of Correction
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2
3
4
licensee will submit LIC 279, updated facility sketch, and writing instructions of remodel with start date, end date, days, hours the workers will be working, how licensee will ensure the safe of the children, to CCLD by 12/7/2022, via email: Martina.Jimenez@dss.ca.gov
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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: 11/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022


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