<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216193
Report Date: 11/09/2021
Date Signed: 11/09/2021 01:29:21 PM

Document Has Been Signed on 11/09/2021 01:29 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:GUZMAN FAMILY CHILD CAREFACILITY NUMBER:
426216193
ADMINISTRATOR:CECILIA GUZMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 868-9329
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/09/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cecilia GuzmanTIME COMPLETED:
01:50 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 11/09/21, at 11:00 AM, Licensing Program Analyst (LPA) Francisca Velazquez made an announced Pre-licensing Inspection of the home. LPA met with Cecilia Guzman, the Applicant of the home and explained the purpose of the inspection. Applicant submitted an application to operate a Large Family Child Care Home on 09/16/21. Applicant stated that when licensed, Applicant would like to operate from Monday through Friday from 7 AM- 5:30 PM. LPA observed no children on site during the inspection.

LPA toured the interior and exterior of the home with the Applicant. The home is a three bedroom, two in a half bath single story dwelling. Applicant stated the home’s living room, dining room/kitchen, converted garage, restroom in the garage, Applicant's master bedroom and backyard will be accessible to children in care. While the two (2) bedrooms, two (2) bathrooms and side of backyard will be excluded from child care services. LPA observed child safety door knobs in two (2) bedroom doors and restroom door, making these area inaccessible.

LPA observed the home to be clean, orderly and free of hazards. The bathroom to be used for children care is observed to be clean and free of toxins with plenty of hand soap, paper towels. LPA advised to add a hand washing poster to help children. Medication in the home is located in an elevated cabinet in the hallway of the home and are inaccessible to children in care. Detergents and cleaning compounds are stored in the garage in an high elevated cabinet and are inaccessible to children in care. LPA observed combination carbon monoxide and smoke detectors in the home which was found to be operable. Detector was tested at 11:32 AM. The home has appropriate heating and ventilation. LPA observed a regulation fire extinguisher on site which was purchased on 10/12/21. LPA reminded the Applicant to purchase or service a regulation fire extinguisher annually. The Applicant informed LPA no firearm or ammunition is on site.

CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216193
VISIT DATE: 11/09/2021
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
26
27
28
29
30
31
32
The backyard is enclosed by wooden fencing and the footing is made up of grass and a concrete slab. The area entry/exit gates are secured. The backyard is free of hazards. LAP observed a built in shed that is used a storage. LPA observed that built in shed is locked and requires a key from Applicant to be able to open the shed. Applicant stated that she will be adding a fence to make the side of the yard is inaccessible to children in care. The side of the backyard that will be inaccessible to children is under construction at the moment. Construction workers only have access to the side of the backyard and do not have any access to the home of the day care areas. LPA observed no bodies of water are on site.

The Applicant completed Preventative Health training on 08/13/21. Further, the applicant completed Mandated Reporter training on 07/31/21 and is valid until 7/31/23. The Applicant’s Pediatric CPR and First Aid certificate expires on 07/04/2023 (EMSA approved). LPA reviewed Applicant's control of property documents. Applicant does not have liability insurance at this time. LPA informed applicant to ensure parents sign a waiver for the liability insurance. Applicant was provided LIC 282 form. Applicant provided work verification letter from CAPSLO Migrant and Seasonal Head Start Program verifying employment from 5/12/03 through 2/16/10.



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

LPA discussed the safe sleep regulations with applicant 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 provided, reviewed and left a copy of safe sleep regulations and LIC 9227 to applicant. LPA also informed applicant 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. Applicant was informed baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216193
VISIT DATE: 11/09/2021
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
26
27
28
29
30
31
32
LPA provided Pre-licensing packet to Applicant. LPA reviewed and issued the Applicant updated samples of state required forms to be kept in the children's record. LPA also discussed the effects of Lead Exposure as well as literature related to COVID 19- Guidance for Child Care Providers and Programs.

LPA discussed the following 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.
· 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.

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

Applicant was made aware that it is Applicant's responsibility to know the regulations for Family Child Care Home (FCCH) which can be accessed on-line at www.ccld.ca.gov.



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

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216193
VISIT DATE: 11/09/2021
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
26
27
28
29
30
31
32
Today's inspection and review of report was conducted in Spanish as it is the Applicant's primary language.

The home meets the requirement for a Large FCCH. License to operate a FCCH is effective today, 11/09/21.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

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

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4