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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216047
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:50:43 PM

Document Has Been Signed on 09/22/2021 03:50 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:ESPINOSA FAMILY CHILD CAREFACILITY NUMBER:
426216047
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Andrea EspinosaTIME COMPLETED:
04:00 PM
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On 9/22/21, at 2:10 PM, Licensing Program Analyst (LPA )Francisca Velazquez conducted an unannounced Required inspection of the facility. Prior to inspection, LPA completed COVID-19 pre-screening questionnaire with Licensee, based on responses it was determined that there are no COVID-19 exposures in the facility. LPA met with Andrea Espinosa, 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. This home consists of two (2) bedrooms, one (1) bathroom single level home with a detached studio. The home’s living room, backyard and restroom are used for child care services, while remainder of the home is excluded from child care. At the time of the inspection, five (5) children are present.

Required forms are predominantly posted on the wall at the entry of the home. The home’s living room has a fireplace which is barricaded by a large cabinet. LPA observed a smoke and carbon monoxide detector in the ceiling of the living room. The detectors were not tested due to children napping during the inspection. Licensee mentioned that both carbon monoxide and smoke detector were tested last week and were functioning appropriately. The home has a regulation fire extinguisher which was purchased on 10/27/20. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services.

The home was clean, orderly and has ventilation to afford for the children’s comfort and safety. Further, the home was void of hazardous items. Medication in the home is stored in a high cabinet in the kitchen and are inaccessible to children. Cleaning compounds are stored in the laundry room which is inaccessible to children. LPA observed sharps are stored in a high cabinet in the kitchen and inaccessible to children. Toys, furniture and equipment observed in the home are safe, varied and age appropriate.

CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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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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: ESPINOSA FAMILY CHILD CARE
FACILITY NUMBER: 426216047
VISIT DATE: 09/22/2021
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The backyard is completely fenced. LPA observed a shed in the backyard that was locked and inaccessible to children in care. LPA observed plastic slide and other gross motor activities accessible to children in care. The fence’s entry/exit gates were secure. Toys and play equipment observed in backyard are safe, varied, age appropriate and in satisfactory condition. No bodies of water were observed on site.

LPA observed and inspected detached studio. Licensee stated that her cousin lives in the studio. Licensee's cousin is fingerprint cleared. Licensee stated that child do not have any access to the studio and her cousin is not around the children. Per Licensee, her cousin is the only individual that lives in the detached studio.



LPA reviewed children records. The records were current, complete and possessed emergency contact information as mandated by regulations. The Licensee's records are also current and complete with CPR and First Aid certifications expiring on 7/8/22. LPA observed a Mandated Reporter Certification which expires on 7/8/22. LPA reviewed facility roster and found roster to be up to date. Late emergency drill conducted in the facility was today 9/22/21.

The Licensee possess no firearms or ammunition are stored on site.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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: www.ada.gov/childqanda.htm

LPA discussed COVID-19 best practices and guidance. Likewise, LPA discussed safe sleep regulations with the Licensee. Licensee was reminded that it is her responsibility to know the regulations for FCCH which can be accessed on-line at www.ccld.ca.gov.

There were no deficiencies cited at this time.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
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