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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214357
Report Date: 04/11/2022
Date Signed: 04/11/2022 02:03:08 PM

Document Has Been Signed on 04/11/2022 02:03 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: 14CENSUS: 10DATE:
04/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Maria PerezTIME COMPLETED:
02:20 PM
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On 04/11/22, at 12:40 PM Licensing Program Analysts (LPAs) Francisca Velazquez and Francisco Pedroza conducted an unannounced Required inspection of the abovementioned Family Child Care Home (FCCH). LPA's conducted COVID-19 pre-screening questionnaire and based on Licensee's responses it was determined to be safe and health. LPAs met with Maria Perez, Licensee of the FCCH and explained the nature and purpose of the inspection. LPAs notes ten (10) children are on site, along with Assistant, Maria Novoa.

LPAs, in the company of the Licensee, toured the exterior and interior of the FCCH. This is a two-story home with three (3) bedrooms and three bathrooms. The home’s living room, kitchen and dining area, daycare room, bathroom and outdoor yard are used for child care services. Conversely, the whole second floor, laundry room and garage are excluded from childcare services. LPA notes that the second floor is made inaccessible by means of a baby gate located in the first step of the stairs. LPA notes that the laundry room is locked and inaccessible to children in care.

The FCCH is orderly and has ventilation to afford for the children’s comfort and safety. Medication in the FCCH is stored in an elevated cabinet in the kitchen. Sharps are stored in an elevated cabinet in the kitchen. Cleaning compounds were observed to be stored in the laundry room that is also inaccessible to children in care. Toys, furniture and equipment observed in the FCCH are age appropriate.

Required forms are posted on the FCCH day-care room. The FCCH has smoke and carbon monoxide detector. Detector was not tested due to children napping during the time of our inspection. Per licensee, drills are conducted monthly due to Licensee having a contract with CAPSLO's Migrant Sesonal Head Start Program. The FCCH has a regulation fire extinguisher which was purchased 6/22/2021. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill documentation. The last drill was completed on 2/25/22. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 04/11/2022
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The outdoor play yard is completed fenced. LPA notes that the side yard are made inaccessible by fences. LPA observed one (1) shed that is used as storage that was locked. Toys, furniture and equipment observed in the yard are age appropriate. LPA notes that the yard affords plenty of shade for the children. LPA observed that drinking water is accessible outdoor by means of a water jug and disposable cups. LPA observed no bodies of water on site.


A sampling of the children's records were reviewed. The records are current, complete and possessed emergency contact information. The Licensee's records were also reviewed and found to be incomplete. Licensee’s Pediatric CPR and First (EMSA approved) expires 7/20/2021. Licensee has Mandated Reporter certificate 8/4/2021. LPA reviewed Assistant's records and found them to be current. Assistant's Pediatric CPR and First aid was taken 9/22/2021 and Mandated Reporter certificate on 9/2/2021.

The Licensee notes no firearms or ammunition are stored on site.

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: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 [facility representative] 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. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
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: 04/11/2022
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A notice of site visit was given and must remain posted for 30 days.

Exit interview and report was reviewed with the licensee, Maria Perez. This inspection and review of report was conducted in Spanish due to Spanish being the primary language of the licensee.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC809 (FAS) - (06/04)
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