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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215977
Report Date: 08/07/2024
Date Signed: 08/07/2024 06:03:14 PM

Document Has Been Signed on 08/07/2024 06:03 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:AYALA FCC AKA EL SHADDAI DAYCAREFACILITY NUMBER:
426215977
ADMINISTRATOR/
DIRECTOR:		NANCY AYALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 264-3499
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 20CENSUS: 9DATE:
08/07/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:36 PM
MET WITH:Nancy AyalaTIME VISIT/
INSPECTION COMPLETED:
06:25 PM
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On August 8, 2024, Licensing Program Analysts (LPAs) Martina Jimenez and Matthew Sapien, conducted an unannounced Triennial inspection at above Family Child Care Home (FCCH). LPA met with Nancy Ayala, licensee, and Angelica Martinez De Ada, Assistant/mother. LPA discussed the purpose of the inspection and together LPA and licensee toured the inside and outside of the home.

FCCH operates from Monday to Friday, from 5:30 AM to 5:30 PM. Licensee cares for children ages 0 to 12 years of age.

LPAs observed, one (1) infant and eight (8) children in care at the time of the inspection. The required licensing forms were posted at the day care area. FCCH utilizes living room, dining, kitchen, playroom, bathroom and completely fenced backyard.

LPAs observed the four (4) bedrooms, and two (2) bathroom inaccessible to children in care. LPAs notes, all bedroom doors and bathroom doors have safety knobs making these areas inaccessible to children in care.

LPAs observed that knives and medication are stored in an elevated cabinet and a

This Report Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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: AYALA FCC AKA EL SHADDAI DAYCARE
FACILITY NUMBER: 426215977
VISIT DATE: 08/07/2024
NARRATIVE
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secured in the kitchen inaccessible at the time of the inspection. LPAs observed an unsecured drawer in the kitchen with knives, wine cork screw bottle open, and potato peeler, accessible to children at the time of the inspection.

Cleaning compounds were observed kitchen cabinet and laundry room that were secured at the time of the inspection making the cleaning compounds inaccessible to children in care. LPAs observed in the children's bathroom Chlorhexidine Gluconate 0.12% oral rinse, tweezer, accessible to children in care. LPAs observed child size furniture and material for activities throughout the home in areas that will be accessible to children in care.

LPAs observed a regulation fire extinguisher that was serviced on 08/07/2024. Smoke and carbon monoxide detectors were tested at 4:03 pm and found functional at the time of the inspection. Licensee stated there are no guns nor ammunition in the home.

LPAs and licensee toured the outdoor play area. LPAs observed a ladder, paint, and garden tools, in an unsecured storage shed, in the children's play area. LPAs observed the exits to be secured. LPAs observed there is shading to afford the children in care. The play area has age-appropriate toys and day-care equipment. LPAs advised the licensee children must never be unsupervised while the children are at the play area.



· No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

This Report Continues on LIC809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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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: AYALA FCC AKA EL SHADDAI DAYCARE
FACILITY NUMBER: 426215977
VISIT DATE: 08/07/2024
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LPAs reviewed the facility file and that revealed Licensee's the Pediatric CPR and First Aid certificate expires on 02/24/2026. Licensee, Mandated Reporter Training expires on 11/23/2024. Children’s records were reviewed and found complete. Control of property was not available at the time of the inspection. FCCH conducts and logs the fire and disaster drills every 6 months, last drill was conducted on 06/14/2024.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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.

LPAs discussed the safe sleep regulations with licensee, Nancy Ayala, 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.

This Report Continues on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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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: AYALA FCC AKA EL SHADDAI DAYCARE
FACILITY NUMBER: 426215977
VISIT DATE: 08/07/2024
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LPAs also informed licensee, 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.

Licensee is not providing Incidental Medical Services (IMS). 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/.

Licensee, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

On this date, 08/07/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility


addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

This Report Continues on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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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: AYALA FCC AKA EL SHADDAI DAYCARE
FACILITY NUMBER: 426215977
VISIT DATE: 08/07/2024
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Today, deficiency cited under Title 22 Division 12 Appeal rights given.
Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

A notice of site visit was given to applicant, and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the licensee, Nancy Ayala.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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Document Has Been Signed on 08/07/2024 06:03 PM - It Cannot Be Edited


Created By: Martina Jimenez On 08/07/2024 at 05:33 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: AYALA FCC AKA EL SHADDAI DAYCARE
FACILITY NUMBER: 426215977

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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
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Based on observation, the licensee did not comply with the section cited above LPAs observed an unsecured drawer in the kitchen with knives, wine cork screw bottle open, and potato peeler, LPAs observed in the children's bathroom Chlorhexidine Gluconate 0.12% oral rinse, tweezer, accessible to the children in care. LPAs observed a ladder, paint, and garden tools, in an unsecured storage shed, in the children's play area. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2024
Plan of Correction
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Licensee will submit photos of correction, and submit in written statement on how licensee will prevent future incidents from occurring to CCLD by 8/8/2024, via email: Martina.Jimenez@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024


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