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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216036
Report Date: 08/25/2023
Date Signed: 08/25/2023 02:02:02 PM

Document Has Been Signed on 08/25/2023 02:02 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GUZMAN FAMILY CHILD CAREFACILITY NUMBER:
426216036
ADMINISTRATOR:MARIA PANTOJAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 245-4684
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
08/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria Pantoja, Javier Guzman TIME COMPLETED:
02:00 PM
NARRATIVE
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On August 25th, 2023 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unnannounced One Year Required visit at the above-mentioned Family Child Care Home (FCCH). LPA me with Licensees Maria Pantoja and Javier Guzman. LPA in the company of the Licensee's toured the interior and exterior of the the FCCH. The home's living room/dining room, one bedroom, one bathroom, front yard and back yard are are used for child care while the remainder of the home is excluded. LPA observed 3 children in care and an assistant present.

LPA observed age appropriate toys, furniture and equipment in the FCCH's interior. LPA observed the restroom used by children to be clean. LPA observed shampoo left out in in the restroom and advised the Licensee to make it inaccessible to the children in care. LPA observed Licensee store it under the sink which is locked with a child proof lock. LPA observed cleaning compounds in a fenced area of the backyard inaccessible to the children in care. LPA observed the sharps in to be stored in a kitchen drawer which is made inaccessible to children by a child gate that at the entry way of the kitchen.

LPA observed the License to be posted in the living room wall. LPA did not observe the Notification of Parent's Rights or the Emergency Disaster Plan posted and informed the Licensees that they must be posted. During the inspection Licensees posted the required documents on a prominent area of the FCCH. LPA observed smoke and carbon monoxide detectors in the FCCH. The smoke detector was tested at 9:43AM and the carbon monoxide detector was tested at 9:45. Both were found to be operable. The FCCH has a 3A10BC fire extinguisher that was purchases 8/25/23. LPA reminded the Licensees to either service or purchase a regulation fire extinguisher annually.

The back yard is enclosed by various kinds of fencing. Toys and play equipment observed on site are age appropriate. LPA observed that the front yard is also enclosed by fence and has age appropriate toys and
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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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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Document Has Been Signed on 08/25/2023 02:02 PM - It Cannot Be Edited


Created By: Giovani Gonzalez On 08/25/2023 at 11:51 AM
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: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(1)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (1) Employee's full name.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 1 count of having missing documents in their employee's file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/08/2023
Plan of Correction
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Licensee will provide a copy to the employee's completed file via email by 9/8/2023.
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:Ana Tolentino
LICENSING EVALUATOR NAME:Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2023


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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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216036
VISIT DATE: 08/25/2023
NARRATIVE
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equipment. LPA observed a shed in the backyard that was not locked and informed the Licensee that it must be secured. Licensee put a lock on it.

A sampling of children's records were reviewed and were found to be current and complete. LPA reviewed sleep logs for infants that were not present and observed to be current. Licensees stated that the infants that they care for are only there for half days and do not nap regularly. Licensee's records were reviewed and were found to be complete. LPA observed that the renewed Mandated Reporter training was just the general training and informed the Licensees that they must have the AB1207 compliant training. LPA reviewed the assistant's file which was found to be incomplete. Licensees Pediatric First Aid expires on 9/13/24. Licensee stated that there are no firearms or ammunition in the home.

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 Maria Pantoja 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 licensees 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 licensees 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.
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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216036
VISIT DATE: 08/25/2023
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Licensee Maria Pantoja 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, Licensees, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today's visit 1 Type B deficiency and 3 Technical Violations were 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 Maria Pantoja and Javier Guzman
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC809 (FAS) - (06/04)
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