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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215704
Report Date: 11/10/2021
Date Signed: 11/10/2021 12:53:20 PM

Document Has Been Signed on 11/10/2021 12:53 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:DUTY FAMILY CHILD CAREFACILITY NUMBER:
426215704
ADMINISTRATOR:AMANDA LYNN DUTYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 260-2066
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
11/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Amanda DutyTIME COMPLETED:
01:00 PM
NARRATIVE
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On November 10, 2021 at 10:00 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced 1 Year Required Inspection. LPA asked Covid-19 screening questions prior to entering the home. LPA met with Licensee Amanda Duty and discussed the purpose of the inspection. Licensee provided LPA a tour of the facility inside and out. There were eight (8) children and 2 staff present during the inspection including the Licensee.

During the tour LPA observed the following, required forms are posted in the prominent location. Appropriate fire extinguisher was purchased on 11/10/2021. At 10:30 AM Smoke and carbon monoxide detectors were tested and found functional. Toxins and detergent are locked inaccessible to children in care. LPA observed clean, safe and age appropriate toys. The backyard is completely fenced. LPA observed age appropriate toys and equipment in the outside play area. Nobodies of water was observed. Licensee stated guns and ammunition are stored separately in the vault.

LPA reviewed the following documents, Pediatric CPR and First Aid Card expires 3/20/2023. Licensee's Mandated Reporter Training Certificate expired on 10/18/2020. Licensee's immunization record is complete per SB 792, however, Assistant does not have immunization record on file. Fire and Disaster drill is conducted and logged every 6 months. Last drill was conducted on 7/28/2021. Children’s roster is current. LPA reviewed children records. The records were current, complete and possessed emergency contact information as mandated by regulations.


Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/10/2021 12:53 PM - It Cannot Be Edited


Created By: Gigi Reyes On 11/10/2021 at 11:53 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: DUTY FAMILY CHILD CARE
FACILITY NUMBER: 426215704

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above , Licensee and Asistant's Mandated Reporter Training expired on 10/18/2020 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee and Assistant agreed to take the Mandated Reporter Training per AB 1207 and submit the certificate to CCLD no later than 11/19/2021
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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Based on record review the licensee did not comply with the section cited above, Assistant has no record of immunization in file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee agreed to submit Assistant's proof of immunization to CCLD no later than 11/19/2021
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: 11/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/10/2021 12:53 PM - It Cannot Be Edited


Created By: Gigi Reyes On 11/10/2021 at 11:53 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: DUTY FAMILY CHILD CARE
FACILITY NUMBER: 426215704

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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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Based on interview and record review the licensee did not comply with the section cited above, Child # 2 does not have LIC 9227 on file which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee stated Licensee will obtain the signature of Child # 2's authorized representative during the pick up time today, 11/10/2021
POC Due Date: 11/19/2021
Plan of Correction
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Licensee agreed to submit plan of correction to CCLD no later than 11/19/2021.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 11/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2021


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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: DUTY FAMILY CHILD CARE
FACILITY NUMBER: 426215704
VISIT DATE: 11/10/2021
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

LPA discussed current Safe Sleep and Covid-19 requirements with Licensee.
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.

During today's inspection deficiencies were cited under California Code of Regulation Title 22 Division 12. Deficiencies are documented under LIC 809 D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
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