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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216157
Report Date: 10/01/2021
Date Signed: 10/01/2021 02:48:36 PM

Document Has Been Signed on 10/01/2021 02:48 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:NOVOA FAMILY CHILD CAREFACILITY NUMBER:
426216157
ADMINISTRATOR:ANABEL NOVOAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 922-4192
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
10/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Anabel NovoaTIME COMPLETED:
03:00 PM
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On 10/1/2021 at 11:30 AM, Licensing Program Analysts (LPA) Francisca Velazquez conducted an announced pre-licensing inspection. Due to COVID -19 and California Department of Public Health guidelines of social distancing, LPA asked Applicant Pre- Screening questions related to COVID-19. Applicant’s responses to the Pre-screening questions suggest no COVID-19 exposure on site. LPA met with Applicants, Anabel Novoa, and discussed the purpose of the visit. During this inspection, Applicant's minor daughter was present at the facility along with adult son, Francisco Novoa Jr. that lives in the home.

LPA conducted the physical plant tour of the home. During this tour the following was noted:

Original application lists one (1) Applicant, and two (2) living adults in the home. Applicant applied for a Large Family Child Care on 7/9/2021. Family members residing in the home are three (3) adults and three (3) minor children. All adults in the home are fingerprint cleared. Per Applicant, the operating hours will be Monday through Friday from 6:00 a.m. to 5:00 p.m. Applicant states she wants to care for children from 0 months old to 12 years of age. Fire inspection was granted 8/19/021 by Santa Maria Fire Department.

All areas identified on the facility sketch were inspected. This home consists of three (3) bedroom and two (2) bathrooms, living room, kitchen/dining area and garage and backyard. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed the designated day care area with age appropriate toys, games etc.

Off limit areas included: kitchen, three (3) bedrooms and one (1) bathroom, garage, and part of the backyard are off limits by safety gates or door safety latches.

CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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: NOVOA FAMILY CHILD CARE
FACILITY NUMBER: 426216157
VISIT DATE: 10/01/2021
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Areas used by children included: living room, dining area, one (1) bathroom and backyard are accessible to children in care. LPA observed a fireplace in the living room that is covered and inaccessible to children in care. LPA observed age appropriate toys and napping equipment on the premises. Knives and Applicant's medication are stored in a high locked cabinet in the kitchen and are inaccessible to children in care. The required fire extinguisher 2A10BC was serviced on 6/14/21. LPA observed smoke and carbon monoxide detector in the hallway of the facility. Detectors were tested at 12:06 PM and were functioning at the time of the visit. LPA observed that the restroom is clean and orderly and has plenty of soap, paper towels and hand washing poster for children in care. Per applicant, three are no guns or ammunition in the home. First Aid and emergency kits are available. The Applicant completed the Orientation on 5/7/2021. The Applicant has current Pediatric First Aid and CPR which expires, 1/14/2022. Applicant completed Preventative Health Training and lead exposure prevention training on 8/13/2021. Applicant completed the Mandated Reporter Training on 2/18/2021. Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles. LPA observed that Applicant's canine, Scooby is up to date with vaccines and next due vaccine is 10/8/22. Applicant submitted prove of control of property.

The following was discussed with the applicant:
· Individuals who are 18 years of age or older living in the home or working in the home, must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain the Criminal Record Background Check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization's, and a valid criminal record clearance associated to the facility license.
· A current roster of children enrolled must be available for review and maintained for a period of three years, even after children are no longer attending the facility.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
· Changes in the home should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if applicant moved to another location/ home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements were reviewed and explained. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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: NOVOA FAMILY CHILD CARE
FACILITY NUMBER: 426216157
VISIT DATE: 10/01/2021
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· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a Family Child Care Home, 24/7.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

Incidental Medical Services (IMS) policy was discussed. Applicant is not provided IMS services for children in care. 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: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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.
· All adults living and working in the home shall be made of aware of the Department inspection rights authority.

• Safe Sleep Regulation, (PIN 20-24). Shaken Baby Syndrome, and COVID-19 guidelines. The “Effects of Lead Exposure” brochure is to be distributed to all families at time of enrollment. It is the Applicant's responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.
• Infant up to 12 months of age must be on their backs to sleep, unless there is a medical exemption from a licensed physician that allows for an alternative sleeping position.
• Cribs must be free from all loose articles and objects, including blankets and pillows.
• Mattress must be firm and include a tight-fitted sheet.
• infants must not be forced to sleep, stay awake, or stay in the sleeping area.
• Infants must not be swaddled while in care.
• An infant's head must not be covered while sleeping.

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

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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: NOVOA FAMILY CHILD CARE
FACILITY NUMBER: 426216157
VISIT DATE: 10/01/2021
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• If an infant falls asleep before being placed in a crib, for example, in a provider's arms or stroller, the provider must move the infant to a crib (or play yard for FCCHs) as soon as possible.
Car seats will only be used for transportation and must not be used for sleeping within a childcare facility.
• All pacifiers cannot have anything attached, such as a stuffed animal or a clip meant to attach the pacifier to the infant's clothing.
• Providers must check on sleeping infants (0 to 24 months) every 15 minutes and document their condition to check for signs of distress, which includes, but is not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness.
• Each infant, up to 12 months of age, must have an Individual Infant Sleeping Plan (LIC 9227) on file, which will document the infant's sleeping habits, usual sleep environment, and the infant's rolling abilities.


During this visit, the LPA reviewed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) with the applicant. LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

Forms to be posted
LIC6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License

Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse.
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).

Children’s records requirements: LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children in Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights


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

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: NOVOA FAMILY CHILD CARE
FACILITY NUMBER: 426216157
VISIT DATE: 10/01/2021
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LPA observed COVID-19 posters posted throughout the facility available for families and children in care. Upon arrival Applicant conducted COVID-19 pre-screening questionnaire and checked LPA’s temperature prior to allowing LPA in the facility. Applicant stated that she will conduct COVID-19 pre-screenings and temperature check to all the families she enrolls in her program.

Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

Exit interview was conducted with, Anabel Novoa. This inspection and review of documentation was conducted in Spanish due to Spanish being the Applicant’s primary language. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

The home meets Title 22 Division 12 California Code of Regulations requirements of a Large Family Child Care Home (FCCH). Effective date of license is 10/1/2021.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC809 (FAS) - (06/04)
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