426216160-12-26-2023-17-CC-FVEZ-CL8U38-20221116141306

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216160
Report Date: 11/16/2022
Date Signed: 12/26/2023 12:40:42 PM

Document Has Been Signed on 12/26/2023 12:40 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:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	426216160
ADMINISTRATOR:	MARYPAZ PEREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 863-3416
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	11/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	MaryPaz Perez		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On November 16, 2022, Licensing Program Analysts (LPAs) Francisca Velazquez and Elvin Baddley conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Marypaz Perez, Licensee of the FCCH and explained the purpose of the inspection. LPAs, in the company of Licensee toured the interior and exterior of the FCCH. The home's uses one (1) bedroom, one (1) bathroom, daycare-room and second living room for childcare services. Meanwhile, the entire second floor, formal living room, dining area, kitchen, garage and outdoor yard is off-limits to the children in care. LPAs note eight (8) children present being cared by Licensee and two (2) assistants, Dulce Escobar and Norma Romo. LPA observed children in the daycare room and second living room. The home was clean and orderly. There is plenty of ventilation to afford the children comfort. Further, the home was void of hazardous items. LPAs observed sharps are stored in an elevated cabinet in the kitchen. LPAs observed medication in another elevated cabinet in the kitchen. Licensee stated more medication is stored in Licensee’s bedroom. LPAs observed cleaning compounds in an elevated shelf in the kitchen and in the laundry room. Toys, furniture and equipment within the FCCH are age appropriate. LPAs note that this is a two (2) story home, LPAs observed a gate securing the second floor is inaccessible to the children in care. Required forms are predominantly posted on the wall. There is a fireplace in an off-limits area in the home. LPAs observed a combination smoke and carbon monoxide detectors in the FCCH that was tested at 10:08 AM and found to be operable. Likewise, the home has a regulation fire extinguisher which was serviced on 8/29/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services. Licensee reported the outdoor yard is off-limits due to the outdoor yard needing construction. Licensee has not started construction of the yard and will notify the department when construction starts. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 426216160
	VISIT DATE: 11/16/2022

NARRATIVE

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LPAs toured the exterior of the home and observed that the yard has not been used for childcare services. No bodies of water are observed.

LPAs reviewed Licensee and children's records. LPAs notes children files were available for all children present during today’s inspection. Licensee reported not documenting infant 15 minute check during napping. Licensee understands that 15 minute checks are required for all children under the age of two (2) and stated FCCH will start documenting all infant’s napping. There is a current Pediatric First -aid certificate expiring on 11/18/23. Licensee's Mandated Reporter training certification expires 7/1/23. The Licensee informed LPA no firearms and ammunition are on site.

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: 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.

Type B deficiency are being cited based on LPA’s record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Licensee was provided a copy of their appeal rights.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Marypaz Perez in Spanish due to Spanish being the primary language.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/26/2023 12:40 PM - It Cannot Be Edited

Created By: Francisca Velazquez On 11/16/2022 at 11:28 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: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 426216160
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in that Licensee reported 15 mintue nap check for infants under the age of two (2) years which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/23/2022
	Plan of Correction
1 2 3 4	Licensee will start to document 15 mintue nap checks for all infants under the age of two (2) years. Licensee will submit proof of documenation via email to Francisca.Velazquez@dss.ca.gov by 11/23/22

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Maria Mueller

LICENSING EVALUATOR NAME:

Francisca Velazquez

LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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