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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215922
Report Date: 01/12/2023
Date Signed: 01/13/2023 07:10:52 AM

Document Has Been Signed on 01/13/2023 07:10 AM - 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: 8CENSUS: 1DATE:
01/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Elizabeth Reyes PinaTIME COMPLETED:
04:50 PM
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On January 12, 2023, at 3:30 PM, Licensing Program Analyst (LPA) Reyes conducted an unannounced Case Management Inspection at the Family Child Care Home. (FCCH) LPA met with Licensee, Elizabeth Reyes Pina and discussed the nature of the inspection. There are no day care children present at the time of the inspection, except for Licensee's biological child.

FCCH License is currently under the Inactive Status as of November 28, 2022 and licensee would like to reopen her FCCH and reactivate the license effective January 23, 2023. LPA in the company of Licensee toured the home inside and out. LPA observed required licensing forms are posted in the wall along entrance hallway. There are 5 bedrooms and 2 bathrooms in the home. The areas accessible to children will be living room, one bathroom, kitchen/dining, one bedroom and a portion of the completely fenced backyard. Off limit areas are 4 bedrooms, one bathroom located in the master bedroom, garage and a portion of the backyard which is enclosed and segregated, making it inaccessible to day care children. LPA observed a Trampoline in the off limit backyard area, Licensee stated that trampoline is not going to be used by day care children and gate will be locked. FCCH has a regulatory 2A10BC fire extinguisher which was purchased on 4/30/2022. Carbon monoxide and smoke alarm detectors were tested and found functional. Licensee stated there are no guns or ammunition in the home. LPA did not observe any bodies of water.

LPA reviewed the facility sketch, Licensee was advised to submit a revised Facility Sketch for yard and floor plan to indicate one bedroom as an accessible area to day care children. Licensee will submit the revised facility sketch no later than 1/16/2023.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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: REYES PINA FCC REYES DAY CARE
FACILITY NUMBER: 426215922
VISIT DATE: 01/12/2023
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LPA reviewed the facility file, Pediatric CPR First Aid expires on 4/9/2024. Mandated Reporter Training expires on 3/23/2024. Licensee took the Preventative Health on 11/8/2019, Licensee's immunization record is complete. All Adults in the home have criminal record clearance and Tuberculosis Screening test clearance. Control of Property was reviewed and Property Owner/Landlord Consent was verified.

During today's inspection, no deficiency was cited. LPA advised Licensee that a new License for Small Family Child Care Home will issued.

Notice of Site Visit was issued.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted with Licensee, Elizabeth Reyes Pina. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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