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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216047
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:45:49 AM

Document Has Been Signed on 12/08/2022 11:45 AM - 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: 8CENSUS: 4DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Andrea EspinosaTIME COMPLETED:
12:00 PM
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On December 8, 2022, at 9:30 AM, Licensing Program Analysts (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the Family Child Care Home (FCCH). 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. LPA notes four (4) children were present during this inspection being care for by Licensee and Licensee’s spouse, Jossimar Espinosa. LPA notes that two (2) children are Licensee’s own children.

The FCCH uses the home’s living room, dining room, bathroom, and outdoor yard for childcare services. Meanwhile, LPA observed the kitchen is made inaccessible by means of a baby gate and two (2) bedrooms are made inaccessible by means of door safety knobs. Additionally, LPA observed the laundry room to be made inaccessible by means of door safety knobs. LPA observed children in the living room and dining area. The home was clean and orderly. There is plenty of ventilation to afford the children comfort. LPA observed a fireplace in the living room that is made inaccessible by a large piece of furniture. LPA also observed an open face fire heater that is made inaccessible by means of a small baby gate. In the kitchen, LPA observed sharps are stored in an elevated cabinet in the kitchen. LPA observed stored medication in another elevated cabinet in the kitchen. LPA observed cleaning compounds in the laundry room. LPA notes the laundry room is made inaccessible to children in care by means of a door safety knob. Toys, furniture, and equipment within the FCCH are in good conditions and age appropriate.

Required forms are predominantly posted on the wall. LPA observed a combination smoke and carbon monoxide detector in the home’s living room that was tested at 10:17 AM, and was operable. Likewise, the home has a regulation fire extinguisher which was purchased on December 8, 2022. LPA reminded the Licensee to either service purchase a regulation fire extinguisher annually. The home maintains working telephone services. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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: 12/08/2022
NARRATIVE
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 LPA observed the outdoor yard to be completely fenced. LPA observed the exit doors to be secured. The outdoor yard provides plenty of shading for the children in care. Drinking water is provided by means of individual cups. Toys, furniture, and equipment observed in the outdoor yard are age appropriate and in good conditions. LPA observed a shed that is locked and inaccessible to the children in care. No bodies of water are observed.

This home has a detached studio in the residence. Licensee informed LPA that the individual that lives in the studio does not have any contact with the children in care. Licensee informed LPA that there are a total of three (3) adults living in the residence; Licensee, Licensee’s spouse and Licensee cousin, Carolina Lopez, who lives in the studio. All three (3) are fingerprinted cleared and associated to the FCCH.

LPA reviewed Licensee and children's records. LPA notes children files were available for all children present during today’s inspection. Licensee does not have any infant age children enrolled but is up to date with the infant safe sleep regulations. In addition, LPA reviewed facility roster and found that all children present are documented in the facility roster. LPA reviewed Licensee’s Pediatric First -aid certificate that is valid until August 25, 2024, and Licensee's Mandated Reporter training certification expires August 1, 2024. LPA reviewed emergency drills, the last drill was conducted on 9/13/22. The Licensee informed LPA no firearms and ammunition are on site.

During today’s inspection, LPA followed up on an Unusual Incident Report that was self reported by Licensee on November 17, 2022. Licensee reported that C3, was playing the game of "tag" with other children in the FCCH. While running, C3 tripped and fell on to the shoulder fracturing the collar bone. Licensee informed parent of C3’s injury. Licensee reports, C3 was picked up by parent and taken to the emergency room at Marian Hospital. C3 was diagnosed with a broken collar bone. Licensee reports C3 was out of the FCCH and returned for services on 11/30/22. C3 continues to be enrolled for services. Licensee reported parent was concerned for C3 but reported knowing C3 is active and understands that accidents happen. Licensee reported C3 has one more follow up appointment with his physician.



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: CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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: 12/08/2022
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 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: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/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

for 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.

During today’s visit no deficiency was cited.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Andrea Espinosa.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
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