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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216173
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:04:03 PM

Document Has Been Signed on 09/28/2022 03:04 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:LABOSSIERE-DUARTE FAMILY CHILD CAREFACILITY NUMBER:
426216173
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
09/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sierra Labossiere-DuarteTIME COMPLETED:
03:00 PM
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On 9/28/2022 at 11:30 AM, Licensing Program Analyst Gigi Reyes conducted an unannounced 1 Year Required inspection and met with Licensee, Sierra Lobossiere-Duarte. LPA asked pre screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID 19 exposures on site. LPA discussed the purpose of the inspection. LPA observed 3 infants and one toddler, at 12:30 PM Licensee's minor child arrived from school, totaling to 5 day care children. (3 infants and 2 older children)

LPA toured the interior and exterior of the day care. Day care children were playing when LPA arrived.
LPA observed smoke and carbon monoxide detectors in the home. The regulation fire extinguisher was purchased on 9/28/2022. Bathroom is toxin free. Licensee stated FCCH conducts the fire and disaster drill every six months but did not document it . On 9/19/2022, Licensee self reported to the department that her FCCH received a notification from a Food Program, that she was operating out of ratio and capacity on the following dates 8/5, 8/10, 8/17, 8/24, 8/31/2022. During those dates, there were 4 infants and one toddler present. Licensee stated that she miscalculated the Child #5's birthday not until she was notified by Food Program that she realized her mistake.
The backyard is enclosed by bricks and wooden fence. LPA observed age appropriate toys and play equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home.
LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 6/23/2023 Licensee took the Mandated Reporter Training Certificates which expires on 5/18/2023. Required Licensing forms are posted. LPA advised Licensee to move the postings in a prominent area where parents can see them.
Children's record are found complete with Emergency and Contact information card on file. Licensee checks and documents napping infants every 15 minutes. Infants 0 - 12 months have a signed LIC 9227 Individual Safe Sleeping Plan on file.
Cont. on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LABOSSIERE-DUARTE FAMILY CHILD CARE
FACILITY NUMBER: 426216173
VISIT DATE: 09/28/2022
NARRATIVE
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During today's inspection, Type A and Type B deficiencies were cited under Title 22 Division 12. and Health and Safety Code.

LPA Reyes informed licensee Ms. Lobossiere that this report dated 9/28/2022 documents one Type A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.
Also, LPA Reyes informed the licensee, Ms. Lobossiere to provide a copy of this licensing report dated 9/28/2022 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.



Cont on LIC 809 C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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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: LABOSSIERE-DUARTE FAMILY CHILD CARE
FACILITY NUMBER: 426216173
VISIT DATE: 09/28/2022
NARRATIVE
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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 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
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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Sierra Labossiere-Duarte
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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Document Has Been Signed on 09/28/2022 03:04 PM - It Cannot Be Edited


Created By: Gigi Reyes On 09/28/2022 at 01:55 PM
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: LABOSSIERE-DUARTE FAMILY CHILD CARE
FACILITY NUMBER: 426216173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(2)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, , the licensee did not comply with the section cited above, Licensee self reported that on 8/5, 8/10, 8/17, 8/24, 8/31/2022, she was operating out of ratio and capacity, there were 4 infants and 1 older child present at day care which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2022
Plan of Correction
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Licensee agreed to submit a written plan of correction to CCL no later than 9/29/2022 on how to prevent the same incident from occurring.
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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022


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Document Has Been Signed on 09/28/2022 03:04 PM - It Cannot Be Edited


Created By: Gigi Reyes On 09/28/2022 at 02:22 PM
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: LABOSSIERE-DUARTE FAMILY CHILD CARE
FACILITY NUMBER: 426216173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1

1. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, , the licensee did not comply with the section cited above. licensee stated she conducted fire and disaster drill but did not document it which pose/poses a potential risk to health and safety of persons in care.
POC Due Date: 10/10/2022
Plan of Correction
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Licensee agreed to submit plan of correction to CCL on or before 10/10/2022 on how to to ensure that fire and disaster drill conducted shal l also be documented.
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:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022


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