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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216192
Report Date: 10/20/2021
Date Signed: 10/20/2021 05:03:48 PM

Document Has Been Signed on 10/20/2021 05:03 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:DAVISON FAMILY CHILD CAREFACILITY NUMBER:
426216192
ADMINISTRATOR:EDITH DAVISONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 720-6633
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/20/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Edith DavisonTIME COMPLETED:
03:20 PM
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This is a Change of Location, previous License no. was 426209367
On 10/20/2021 at 1:40 PM Licensing Program Analyst (LPA) Gigi Reyes conducted an announced Pre Licensing inspection and met with applicant, Edith Davison. LPA asked applicant of pre- screening questions related to COVID-19, Applicant's responses suggest no COVID-19 exposure on site. LPA met with applicant and discussed the purpose of the Inspection. There were no children present.

LPA conducted the inspection of the interior and exterior of the home. During this tour the following was noted:
Applicant applied for change of location on 9/10/2021. Per Applicant, the operating hours will be Monday through Friday from 7:00 PM to 5:00 PM. Applicant states she wants to care for children from 0 month old to 12 years of age.

All areas identified on the facility sketch were inspected. Home is a one story composed of 3 bedrooms and 2 bathrooms. The designated day care area is a sun room located at the back side of the home adjacent to the living room. Three bedrooms are not accessible to children. The backyard is completely fence. LPA did not observe any bodies of water.

Continued on LIC 809 C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2021
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: DAVISON FAMILY CHILD CARE
FACILITY NUMBER: 426216192
VISIT DATE: 10/20/2021
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At 2:00 PM smoke detector and carbon monoxide detector were tested and were functioning at the time of the visit. Per Applicant, there are no guns nor ammunition in the home.

First Aid and emergency kits are available. The Applicant's First Aid and CPR expires 7/23/2023. Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles. Applicant completed the Preventative Health Training on 9/30/2021.

LPA discussed Safe Sleep Regulations with Applicant.

Applicant is not providing Incidental Medical Services (IMS). 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.

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.



Control of Property was reviewed.

Fire Safety Inspection Clearance was granted on 10/18/2021.
Continued on LIC 809 C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
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: DAVISON FAMILY CHILD CARE
FACILITY NUMBER: 426216192
VISIT DATE: 10/20/2021
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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 Edith Davison.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.


Issuance of Large Family Child Care Home License is pending subject to completion of the following corrections. Plan of Corrections will be submitted no later than October 29, 2021.

1. Setting up of day care area, presence of age appropriate toys and equipment, sleeping cots and play pen.

2. Clearing of the back yard of small dried branches that are hazard trip

3. Presence of age appropriate play equipment for the outdoor area.

4. Removal of cable cord in the living room.

5. Installation of child safety lock in the three bedroom doors.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
LIC809 (FAS) - (06/04)
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