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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214357
Report Date: 08/03/2021
Date Signed: 08/03/2021 03:34:46 PM

Document Has Been Signed on 08/03/2021 03:34 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
426214357
ADMINISTRATOR:MARIA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 714-3214
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
08/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Maria PerezTIME COMPLETED:
03:45 PM
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On 8/3/21, at 1:55 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted a Required Inspection of the facility. Prior to entering the facility, LPA completed COVID-19 pre-screening questionnaire with Licensee and based on Licensee's responses it was determined that facility did not have COVID-19 exposures. LPA met with Maria Perez, Licensee of the facility and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the facility. This is a two (2) story home that consists of four (4) bedrooms, three (3) bathrooms, living room/dining area, kitchen, garage and backyard. Licensee stated that children have access to the one (1) bedroom located in the first floor, two (2) bathrooms, the dining area and backyard while the whole second floor is off limits to children and made inaccessible by a small gate located on the first step of the stairway, along with the laundry room and garage. At the time of the inspection nine (9) children are present along with Assistant, Anabel Novoa. Licensee has two canine’s in the facility, Snowball and Spiky. Licensee stated that Snowball is an outdoor pet and Spiky is an indoor pet.

The home was orderly and clean with proper ventilation for all children in care. The bathrooms used for care are clean and free of toxins with hand washing poster for the children. All cabinets in the bathrooms have safety latches making them inaccessible to children in care. LPA observed a fire place in the living room that is covered and made inaccessible to children. LPA observed that all kitchen cabinets have safety latches making them inaccessible to children in care. LPA observed that sharps and knives are stored in the kitchen on a high cabinet that is locked and inaccessible to children in care. LPA observed that cleaning compounds are stored in a high cabinet in the kitchen and also in the laundry room, both areas are inaccessible to children in care. LPA observed that laundry room has a double safety latches to ensure it is off-limits to the children in care. LPA observed that household medications are stored in the kitchen in a high cabinet that is locked and inaccessible to children in care Toys, furniture and equipment in the facility are age appropriate.

CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2021
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 426214357
VISIT DATE: 08/03/2021
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LPA observed required licensing forms and documents post by the day care room. LPA observed smoke detector and carbon monoxide detector located on the ceiling of the hallway. Both smoke detectors were not tested during inspection due to most children napping. LPA observed that both detectors had flashing green light indicating that there are operating. Licensee stated that batteries were changed about two (2) months ago. LPA observed a regulation fire extinguisher that was purchased 6/22/21. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill log. The most recent fire drill conducted and documented on 7/2/21.

LPA observed that the backyard is completely fenced. LPA observed plenty of gross motor activities and identified learning areas for children in care. Toys and play equipment observed in backyard are age appropriate and in good conditions. LPA observed that both sides of the yard are made inaccessible by a fence on each side. Behind one fence, LPA observed two sheds that are locked and made inaccessible to children in care by a small gate. Behind the other fence, LPA observed that Licensee canine is housed behind the fence. Canine’s area is clean and inaccessible to the children in care. LPA observed no bodies of water on site.

Licensee informed LPA no firearms or ammunition are stored on site.

LPA reviewed a sampling of the children records. All records reviewed are current and contains complete emergency card information. Facilities current roster of children was reviewed by the LPA during inspection. All children present during the inspection are noted in the roster. LPA reviewed the Licensee's Pediatric CPR and First Aid certifications which expires 7/20/23 and Mandated Reporter Training Certificate expiring on 8/13/21. Assistant, Anabel Novoa’s CPR and First Aid certifications expires 1/14/22 and Mandated Reporter Training Certificate expires 2/18/22. LPA reviewed Snowball and Spiky, Licensee’s canines immunization records and found canines to be up to date with all immunization's until 2/5/22 and 12/11/23.

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
LIC 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 426214357
VISIT DATE: 08/03/2021
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LPA discussed COVID 19 guidance and best practices with the Licensee. LPA discussed safe sleep regulations with the Licensee. Licensee stated that she is aware of the new safe sleep regulations and has received two training's through CAPSLO’s Seasonal Migrant program and through her local resource and referral office. License is currently logging infant sleep logs for all infants in the facility. Licensee was reminded that it is Licensee's responsibility to know the regulations for a FCCH which can be accessed on-line at www.ccld.ca.gov.

In areas evaluated, there were no deficiencies cited at this time.

Today's inspection and review of report was conducted in Spanish due to Licensee being primarily Spanish speaking.

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: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
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