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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
426215935
Report Date:
09/06/2022
Date Signed:
09/07/2022 09:40:19 AM
Document Has Been Signed on
09/07/2022 09:40 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
3
DATE:
09/06/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:30 AM
MET WITH:
Cruz Vargas Valdez
TIME COMPLETED:
05:46 PM
NARRATIVE
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On 9/6/22, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Cruz Vargas Valdez, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of Licensee toured the interior and exterior of the FCCH. The home's day-care area, bathroom and outdoor yard are used for childcare services, while all bedrooms, living room, kitchen and dinning areas are off limits by means of baby gate. At the time of the inspection, there are three (3) children present.
Upon arrival, Licensee open the door and asked LPA if we can hurry to the outdoor yard because there was children in the yard playing with water. At about 10:35 am, LPA observed a splash pool being used. LPA did not observe children right away and then noticed that two (2) infant age children were playing in the playhouse right next to the splash pool. LPA observed the outdoor yard and observed items that could poses a danger to children in care. Items observed were propane tank, BBQ pit with attached propane in the outdoor yard, spray paint bottles, paint, broken logs and equipment accessible to children. LPA observed that the garage was not locked. At 11:04 am, upon inspecting the garage, LPA observe a beauty business set up in the garage area. Licensee stated that she has a body sculpting business that is done after day care hours and during the weekend.
The home was clean and orderly. LPA notes that there is very little to no ventilation in the home. Licensee stated that the air conditioner does not work. LPA observed a small fan in the day-care room area, however LPA notes that the home is still hot. The home was void of hazardous items. Medication and sharps are stored in an elevated kitchen cabinet which is secure and beyond the reach of children. Cleaning compounds were observed in the laundry room and under the sink, both areas are inaccessible to children in care. Toys, furniture and napping equipment within the FCCH are age appropriate.
CONT 809-C
SUPERVISORS NAME
:
Maria Mueller
LICENSING EVALUATOR NAME
:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
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
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in the fire extinguisher in the facility was purchased on 4/9/20 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to purchase or service the fire extinguisher and to hang it on the wall. Licensee will submit proof of purchase or service to LPA Velazquez via email by 9/13/22 at Francisca.Velazquez@dss.ca.gov
Type B
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that LPA observed propane tank in the outdoor play yard, BBQ with another propane tank attached, spray paint and paint bottles, and broken equipment accessible to children in the outdoor yard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to remove all items that could poses a danger to the children in care and submit pictures to LPA Velazquez via email by 9/13/22 to Francisca.Velazquez@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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
8
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)
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.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above due to the facility not having an emergency disaster plan available in the home for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to complete LIC610 and to post it by the parent area or phone by 9/13/22. Licensee agrees to submit a copy of LIC610 to LPA Velazquez by 9/13/22 via email to Francisca.Velazquez@dss.ca.gov
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
5
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)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: (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. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that the Licensee reported not conducting or documenting emergency drill logs which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to conduct an emergency drill by 9/13/22 and submit written proof to LPA Velazquez by 9/13/22 via email at Francisca.Velazquez@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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
11
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(B)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that Licensee is not checking or documenting very 15 minutes when an infant is sleeping which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to attend a course on safe sleep regulations and submit a written summary of what was learned in this course. Licensee will start document 15 minute checks for every infant that is enrolled in the facility.
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
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in Licensee does not have a mandated reporter training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to complete AB1207 and submit completion certificate by 9/13/22 to LPA Velazquez via email at Francisca.Velazquez@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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
13
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that the Licensee did not have her immunization's readily available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to collect proof of her immunization's and submit to LPA Velazquez by 9/13/22 via email at Francisca.Velazquez@dss.ca.gov.
Type B
Section Cited
CCR
102416.3(a)(6)
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: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in a bedroom identified as off-limits is now used as a napping room. Licensee stated that this change was not reported to our office which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to update facility sketch and submit to LPA Velazquez by 9/13/22 via email at Francisca.Velazquez@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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
4
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that out of the three (3) infants present, Licensee only had one (1) emergency card which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to collect emergency cards for all children enrolled for services by 9/13/22 and submit proof to LPA Velazquez via email at Francisca.Velazquez@dss.ca.gov
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in there are no immunization records for the three (3) infants present during this inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to collect immunization's records for all children enrolled for day care services by 9/13/22 and submit proof to LPA Velazquez by 9/13/22 via email at Francisca.Velazquez@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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
3
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that there are no children files with necessary documentation available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to created child files and ensure that all documents required are on file readily available for review. Licensee agrees to submit proof to LPA Velazquez via email at Francisca.Velazquez@dss.ca.gov by 9/13/22
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in the facility does not have a current and up to date facility roster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to create facility roster and ensure that it stay up to date. Licensee agrees to submit a copy of facility roster to LPA Velazquez via email at Francisca. Velazquez by 9/13/22.
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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
15
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in none of the children present had a child file with LIC995A signed and on record which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to ensure that all enrolled children have LIC 995A in the child file for review by 9/13/22. Licensee agrees to submit proof to LPA Velazquez via email at Francisca.Velazquez@dss.ca.gov by 9/13/22.
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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
2
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that no children present have signed affidavits from parent/guardian regarding facility not carrying liability insurance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to update all her children files and ensure that signed affidavit is updated for all children enrolled. Licensee will submit proof to LPA Velazquez via email at Francisca.Velazquez@dss.ca.gov by 9/13/22.
Section Cited
Infant Safe Sleep
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
9
of
15
Document Has Been Signed on
09/07/2022 09:40 AM
- It Cannot Be Edited
Created By:
Francisca Velazquez
On
09/06/2022
at
03:03 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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
09/06/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in that the Licensee is not checking on napping infants every 15 minutes and is not documenting the checks which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/13/2022
Plan of Correction
1
2
3
4
Licensee agrees to start checking on napping infant every 15 minutes and agrees to document every time Licensee checks on a napping infant. Licensee agrees to submit proof to LPA Velazquez via email at Francisca.Velazquez@dss.ca.gov by 9/13/22.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
14
of
15
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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
VISIT DATE:
09/06/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
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11
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LPA observed facility license and notification of parents rights were the only documents posted. The FCCH has a fireplace that was locked and/or made inaccessible to children in care. LPA observed smoke and carbon monoxide detectors in the FCCH which were each tested at 11:46 am, and found to be operable. The home does not have a regulation fire extinguisher that has been serviced or purchased within one (1) year. Licensee stated that the fire extinguisher in the home was purchased for the pre-licensing visit in 4/9/20. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services.
The backyard is made up of grass footing and cement area and is enclosed by wood fencing. The fence’s entry/exit gates are secure. Toys and play equipment observed in backyard are age appropriate. No bodies of water are observed.
LPA reviewed Licensee and children's records. LPA notes children records and Licensee records are incomplete. Out of the three (3) infant present, Licensee only had an emergency card for one (1) child, no other forms were available for review. LPA attempted to review Licensee's Mandated Reporter training certification; Licensee did not have certificate for review. LPA reviewed Licensee's Pediatric CPR and First Aid certification taken 2/28/22. Facility roster, emergency drill logs and Infant safe sleep 15 minute logs were not completed and therefore, not available for review. The Licensee informed LPA no firearms and ammunition are on site.
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:
http://www.ada.gov/childqanda.htm
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.
CONT 809-C
SUPERVISORS NAME
:
Maria Mueller
LICENSING EVALUATOR NAME
:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
12
of
15
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:
VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER:
426215935
VISIT DATE:
09/06/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
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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
for 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.
Type B deficiencies are being cited based on LPA’s observations and record reviews, pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D).
Licensee was provided a copy of their appeal rights.
A Notice of Site visit was given and must remain posted for 30 days.
Exit interview conducted and review of report was translated in Spanish by LPA Velazquez due to Spanish being the Licensee's, Cruz Vargas Valdez primary language.
CONT 809-D
SUPERVISORS NAME
:
Maria Mueller
LICENSING EVALUATOR NAME
:
Francisca Velazquez
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
LIC809
(FAS) - (06/04)
Page:
10
of
15