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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215933
Report Date: 08/08/2022
Date Signed: 08/08/2022 05:08:52 PM

Document Has Been Signed on 08/08/2022 05:08 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:BARRIGA FAMILY CHILD CAREFACILITY NUMBER:
426215933
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
08/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Concepcion Barriga TIME COMPLETED:
05:15 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 8/8//2022, at 1:00 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection, with a change of capacity. LPA met with Concepcion Barriga, Licensee. The purpose of the visit was discussed with the licensee and together we toured the inside and outside of the home. LPA observed 5 children in care at the time of the inspection.

The main day care areas are living room, kitchen, dining room, and hallway bathroom. LPA observed the children's bathroom to be free of toxins. LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include the 3 bedrooms, 1 bathroom and attached garage, which are secured with a chain lock on the doors making the off limit areas inaccessible to children. The backyard is completely fenced. LPA observed age appropriate toys, and, play structure in the backyard. LPA observed three (3) small outdoor dogs secured in the backyard.

LPA observed in the backyard a second home, which consist of two (2) bedrooms and one (1) bathroom approximately 50 feet from the back door to the FCCH. The licensee stated that once the second home has been completed and receives the final approval from the City of Santa Maria, the licensee will reside in the second home and use the first home for child care. The licensee stated that she was not aware that the licensee is to notified CCLD prior to any change to the FCCH or grounds.

Licensee stated there are no weapons and ammunition in the home. Licensee stated she does not hold a foster family license. LPA reviewed the facility roster. LPA a reviewed of the children's file revealed child#2 file is

This REPORT CONTINUES ON LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2022
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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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: BARRIGA FAMILY CHILD CARE
FACILITY NUMBER: 426215933
VISIT DATE: 08/08/2022
NARRATIVE
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missing the consent for medical treatment (LIC 627), as well as the identification and emergency information (LIC700). The fire extinguisher was purchased July 30, 2022. The carbon monoxide detector and smoke alarm
that was tested and functioning at 2:26 PM, that meets statutory requirements. Licensee is current with immunization required per SB 792. The last Safety drill was conducted on August 8, 2022. Licensee's CPR and First Aid which expired October 15, 2021. Licensee has not completed the Mandated Reporter Training required per AB 1207.

Licensee is not providing Incidental Medical Services. 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: htttp://www.ada.gov/childqanda.htm

LPA reviewed with Licensee the Safe Sleep Regulation (PIN 20-24-CCP-SP). LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

The license for change of capacity is pending manager's approval. Today’s visit was conducted in Spanish by LPA Jimenez. Today, deficiency cited under Title 22 Division 12. Spanish Appeal rights were given.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted. 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: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/08/2022 05:08 PM - It Cannot Be Edited


Created By: Martina Jimenez On 08/08/2022 at 03:56 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: BARRIGA FAMILY CHILD CARE
FACILITY NUMBER: 426215933

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2022

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 interview with the licensee, who stated that she has not completed the Mandated Reporter Training required per AB 1207, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2022
Plan of Correction
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Licensee will email CCLD a copy of mandated reporter training certificate by August 22, 2022.

Martina.Jimenez@dss.ca.gov
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review revealed that licensee's CPR and First Aid expired October 15, 2021, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2022
Plan of Correction
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Licensee will email CCLD a copy of current pediatric cardiopulmonary resuscitation and pediatric first aid by August 22, 2022.

Martina.Jimenez@dss.ca.gov
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:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2022


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/08/2022 05:08 PM - It Cannot Be Edited


Created By: Martina Jimenez On 08/08/2022 at 03:56 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: BARRIGA FAMILY CHILD CARE
FACILITY NUMBER: 426215933

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observed in the backyard a second home, which consist of two (2) bedrooms and one (1) bathroom approximately 50 feet from the back door to the FCCH, without notifying CCLD prior to making alterations to the FCCH, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2022
Plan of Correction
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Licensee will submit a written statement on licensee will prevent future incidents to CCLD by August 22, 2022.

Martina.Jimenez@dss.ca.gov
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review revealed that child #2's file was missing the consent for medical treatment (LIC 627), as well as the identification and emergency information (LIC700), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2022
Plan of Correction
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Licensee will email CCLD a copy of child #2's completed the consent for medical treatment (LIC 627), as well as the identification and emergency information (LIC700) by August 22, 2022.

Martina.Jimenez@dss.ca.gov
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:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2022


LIC809 (FAS) - (06/04)
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