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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215935
Report Date: 11/16/2023
Date Signed: 11/16/2023 04:46:53 PM

Document Has Been Signed on 11/16/2023 04:46 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:VALDEZ FCC AKA AMOR'S CHILDCARE SERVICEFACILITY NUMBER:
426215935
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Cruz Vargas ValdezTIME COMPLETED:
05:00 PM
NARRATIVE
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On 11/16/23, at 1:50 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Case Management inspection for a change of capacity. LPA met with Cruz Vargas Valdez, Licensee, and explained the nature/purpose of the inspection.

LPA and Licensee together toured the an interior and exterior of the FCCH. LPA observed one (1) infant and three (3) children napping at the time of the inspection. LPA observed the infant swaddle in the crib, and a pacifier with an attached stuffed animal attached to the pacifier in the crib at the time of the inspection. LPA observed the laundry closet located in the day-care room unsecured upon arrival. LPA observed disinfecting wipes on the floor in the day-care room accessible to child in care. LPA conducted a file reviewed which revealed C1's file had no LIC9227 and safe sleep chart at the time of the inspection.

LPA reviewed the Licensee’s First Aid/ CPR certification which expires on 2/28/2024. LPA observed a regulation fire extinguisher which was serviced on 08/28/2023. The Licensee’s Mandated Reporter Training certificate, was not available at the time of the
inspection. The last fire drill conducted and documented was no available at the time of the inspection as well.

CONTINUES ON LIC 809C & LIC809D
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER: 426215935
VISIT DATE: 11/16/2023
NARRATIVE
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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.

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/.
CONTINUES ON LIC 809C & LIC809D
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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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: VALDEZ FCC AKA AMOR'S CHILDCARE SERVICE
FACILITY NUMBER: 426215935
VISIT DATE: 11/16/2023
NARRATIVE
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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 Cruz Vargas Valdez, licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

On 10/16/23, the Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 10/20/2023.

The home meets Title 22 of CCR requirements for a Large Family Child Care license effective today. Effective date of license is today November 16, 2023. A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days

The inspection visit was conducted in Spanish by LPA Jimenez. Today, deficiency cited under Title 22 Division 12 Appeal rights given. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Cruz Vargas Valdez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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Document Has Been Signed on 11/16/2023 04:46 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/16/2023 at 03:00 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: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2023
Section Cited
CCR
102417(g)(9)

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(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. This requirement is not met as evidenced by:
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Licensee agrees to complete LIC610 and to post it by the parent area or phone by 11/22/23. Licensee agrees to submit a copy of LIC610 to LPA Jimenez by 11/22/23 via email to Martina.Jimenez@dss.ca.gov
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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.
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Type B
11/22/2023
Section Cited
CCR102417(g)(4)

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(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
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Licensee shall submit a written statement on how licensee will prevent future incidents, to CCLD by 11/22/2023, via email: Martina.Jimenez@dss.ca.gov
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be stored where they are inaccessible to children. LPA observed the laundry closet located in the day-care room unsecured upon arrival. LPA observed disinfecting wipes on the floor in the day-care room accessible to child in care. which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


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Document Has Been Signed on 11/16/2023 04:46 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/16/2023 at 03:19 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: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2023
Section Cited
CCR
102417(g)(9)(A)(1)

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(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.
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Licensee agrees to conduct an emergency drill by 11/22/23 and submit written proof to LPA Jimenez by 11/22/23 via email at Martina.Jimenez@dss.ca.gov
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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.
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Type B
11/22/2023
Section Cited
CCR102425(j)(2)(D)(c)

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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: Based on observation and
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Licensee submit a written statement on how licensee will prevent future incidents to CCLD by 11/22/23, via email: Martina.Jimenez@dss.ca.gov Licensee will start document 15 minute checks for every infant that is enrolled in the facility.
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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.
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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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


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Document Has Been Signed on 11/16/2023 04:46 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/16/2023 at 03:40 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: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2023
Section Cited
HSC
1596.8662(b)(1)

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(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
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Licensee agrees to complete Mandated Reporter Training per AB1207 and submit completion certificate by 11/22/23 to LPA Jimenez via email: Martina.Jimenez@dss.ca.gov
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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: 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.
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Type B
11/22/2023
Section Cited
CCR102425(b)(1)(A)

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Pacifiers shall be allowed in the crib or play yard if the following provisions are in place:
(A)There shall not be anything attached to the pacifier. This requirement is not met as evidenced by: Based on LPAs observation of the pacifier with an attached stuff animal
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Licensee will submit a written statement on how licensee will prevent future incident to CCLD by 11/22/23, via email: Martina.Jimenez@dss.ca.gov
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which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


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Document Has Been Signed on 11/16/2023 04:46 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/16/2023 at 03:58 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: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2023
Section Cited
CCR
102425(f)

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An infant shall not be swaddled while in care. This requirement is not met as evidenced by: Upon arrival LPA observed C1 swaddled in the crib, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Licensee shall submit a written statement on how licensee will prevent future incidents, to CCLD by 11/22/2023, via email: Martina.Jimenez@dss.ca.gov

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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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023


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