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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215839
Report Date: 08/28/2024
Date Signed: 08/28/2024 02:15:20 PM

Document Has Been Signed on 08/28/2024 02:15 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:AYALA FAMILY CHILD CARE AKA LITTLE ANGELS DAY CAREFACILITY NUMBER:
426215839
ADMINISTRATOR/
DIRECTOR:		LUIS CARLOS AYALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 291-2029
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/28/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:09 PM
MET WITH:Luis Carlos AyalaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On August 28, 2024 at 12:24 PM, Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced Required- 3 Year inspection. LPA met with licensee Luis Carlos Ayala and spouse Maria and advised them of the purpose for the inspection. Licensee provided LPA a tour of the home inside and out. There were seven children in care at the time of the inspection along with 3 adults in the home.

LPA observed required Licensing required documents posted prominently at the entrance of the home. Fire and earthquake drills was observed to be conducted on 12/15/23. Licensee states they should have done one in May or June of this year. Fire extinguisher 2A10BC located in the original box was observed to be located inside a cabinet. Licensee was not able to provide proof of purchase. LPA reminded Licensee that regulatory fire extinguishers should be purchased or serviced yearly. Dual fire/carbon monoxide detector was tested by the Licensee at 12:41 PM and found to be in working condition.

Children in care have access to two rooms, two restrooms, sun room, living room, and back yard. Fire place inside the living room is screened to prevent access by children. Kitchen cabinets were locked and knives are being kept in a cabinet above counters to keep out of reach from children. Children have access to toys that are age-appropriate inside and outside of the home. Back yard play area is enclosed and has plenty of bicycles, scooters, and activities. There were no bodies of water present at the time of inspection. During the tour, LPA did not observe any hazards/toxins items accessible to children in care. Licensee denies having guns/ammunition in the home.

LPA reviewed five random children files. Two out of five were missing immunization records. Licensee states he thought immunization records were only required for children under one year old. Licensee CPR/first aid is valid through 2/27/2025. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com Licensee’s mandated reporter certification expired 10/03/2022. Per record review, a technical advisory was issued in 2019 indicating renewal of certification shall be conducted every two years.
Continued on 809-C
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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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: AYALA FAMILY CHILD CARE AKA LITTLE ANGELS DAY CARE
FACILITY NUMBER: 426215839
VISIT DATE: 08/28/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 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. Licensee is not currently caring for infant children at the moment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Luis Carlos Ayala, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Continued on 809-C

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

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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: AYALA FAMILY CHILD CARE AKA LITTLE ANGELS DAY CARE
FACILITY NUMBER: 426215839
VISIT DATE: 08/28/2024
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During today's inspection three Type B deficiencies were issued and can be found on the attached 809-D pages. Two technical violations were issued as well.

Physical Plant - Type B: 102417(g)(1) - Licensee states the extinguisher was purchased last year, but does not have proof of purchase.

Physical Plant - Type B: 102417(g)(9)(A) - Licensee stated fire/disaster drills should have been conducted on in May or June.

Facility Administration - Type B: 1596.8662(b)(1) - Licensee does not have a valid mandated reporter certification, and states he was not aware it needed to be conducted every two years.

LPA provided the following resources to Licensee:

- Safe Sleep FAQ's in Spanish.

- Sleep Chart template in Spanish.

- Vaccination Handout in Spanish.

- Entrance Checklist for Family Child Care Homes (LIC126).

- Children's Roster (LIC9040).

- Forms/Records to be kept in the FCCH in Spanish.

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 in Spanish with the licensee Luis Carlos Ayala.

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

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/28/2024 02:15 PM - It Cannot Be Edited


Created By: Susana Martinez On 08/28/2024 at 01:46 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: AYALA FAMILY CHILD CARE AKA LITTLE ANGELS DAY CARE
FACILITY NUMBER: 426215839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in receipt was not available which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2024
Plan of Correction
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Licensee is to submit proof of purchase for new extinguisher.
Type B
Section Cited
CCR
102417(g)(9)(A)
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in facility has not conducted drills which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2024
Plan of Correction
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Licensee is to submit proof of disaster drills.
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: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/28/2024 02:15 PM - It Cannot Be Edited


Created By: Susana Martinez On 08/28/2024 at 01:46 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: AYALA FAMILY CHILD CARE AKA LITTLE ANGELS DAY CARE
FACILITY NUMBER: 426215839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024

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 observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 people do not have a valid certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2024
Plan of Correction
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Licensee is to submit valid certificate to LPA.
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:Ana Tolentino
LICENSING EVALUATOR NAME:Susana Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


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