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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215922
Report Date: 11/28/2022
Date Signed: 11/28/2022 02:10:40 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/28/2022 02:10 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:REYES PINA FCC REYES DAY CAREFACILITY NUMBER:
426215922
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
11/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Elizabeth Pina ReyesTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Martina Jimenez conducted an Case Management Inspection. Licensee was contacted and asked Pre-Screening Covid-19 questions prior to entering the home. Licensee's responses to the questions suggest no COVID-19 exposure on site.

Licensing Program Analyst (LPA) Martina Jimenez made an annual required inspection to the home. LPA met with Elizabeth Reyes Pina, Licensee. LPA advised the licensee the purpose of the inspection and was discussed. There were no children present during the time of the visit. Licensee stated would like to place the FCCH license inactive.

Licensee stated that she is currently not providing day care. Licensee stated that the last date licensee provided care was November 5, 2022. LPA and licensee toured the inside and outside of the home together. Licensee has a 2A10BC fire extinguisher, smoke detector and carbon monoxide detector. Licensee was reminded to service or replace the fire extinguisher yearly. LPA discussed the requirement for all care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA also discussed the new Mandated Reporter training requirements.

Licensee requested to be on Inactive Status. Licensee submitted LIC 9211 (Request for Inactive Child Care License Status) to LPA during the visit.

LPA reviewed the handout "A Child Care Provider's Guide to Safe Sleep (PIN 20-24-CCP-)" and The Effects of Lead. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov.



There were no deficiencies cites at this time. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2022
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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