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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215985
Report Date: 04/08/2024
Date Signed: 04/08/2024 04:45:40 PM

Document Has Been Signed on 04/08/2024 04:45 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:PEREZ FCC AKA HARMONY AND JUBILEEFACILITY NUMBER:
426215985
ADMINISTRATOR/
DIRECTOR:		MAINOR QUEVEDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 455-0516
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
04/08/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On April 08,2024 at 01:15PM, Licensing Program Analysts (LPAs) Joaquin Mendez and Gigi Reyes conducted an unannounced Required 1 Year inspection. LPAs met with licensee Maria Perez and advised the purpose of the inspection. Licensee provided LPAs a tour of the home inside and out. There were (8) children in care with one (1) being an infant at the time of the inspection.

LPAs observed required licensing documents pinned on the walls throughout the home. Fire and earthquake drills are being documented every six months. Last drill was conducted on 12/12/2023. Fire extinguisher 2A10BC on kitchen floor was last serviced 04/27/2023. Fire and carbon monoxide detectors were observed. Licensee stated there was no firearms or ammunition in the home.

Children in care have access to (1) restroom, kitchen, (2) living rooms, and back yard. Fireplace inside the living room has screen and covering to prevent access by children. Licensee states fireplace has never been used. In the kitchen the knives and cleaning supplies are being kept in a cabinet above counters to keep out of reach from children. Children have access to toys that are age-appropriate inside and outside of the home. Back yard play area is fenced and LPAs did not observe any bodies of water. During the tour, LPAs did not observe any hazards/toxins items accessible to children in care.

LPAs reviewed (8) eight children’s files. All children files were current. Licensee CPR/first aid expires on 09/13/2024 while mandated reporter expires on 07/18/2024. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com
Continue on 809C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PEREZ FCC AKA HARMONY AND JUBILEE
FACILITY NUMBER: 426215985
VISIT DATE: 04/08/2024
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 Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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.

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.

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's 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. LPA's observed a safe sleep log being documented for infants in care every 15 minutes. Continued on 809C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PEREZ FCC AKA HARMONY AND JUBILEE
FACILITY NUMBER: 426215985
VISIT DATE: 04/08/2024
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Licensee stated there were no children in care that required 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:

During the exit interview, the Licensee Maria Perez, confirmed that there are no Registered Sex Offenders living in the facility and LPA's completed the RSO profile in FAS.

During today's inspection deficiency was cited and under title 22 division 12. Appeal rights were given and notice of site visit was issued.

Exit interview was conducted and report was reviewed with licensee Maria Perez in Spanish.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/08/2024 04:45 PM - It Cannot Be Edited


Created By: Joaquin Mendez On 04/08/2024 at 04:03 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: PEREZ FCC AKA HARMONY AND JUBILEE
FACILITY NUMBER: 426215985

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (interview) and the observation LPAs observed infant sleeping in playpin covered with a blanket, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/18/2024
Plan of Correction
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Licensee corrected it during the inspection.
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:George Mingle
LICENSING EVALUATOR NAME:Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024


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