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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216193
Report Date: 05/03/2024
Date Signed: 05/06/2024 08:11:10 AM

Document Has Been Signed on 05/06/2024 08:11 AM - 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/
DIRECTOR:		CECILIA GUZMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 868-9329
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
05/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Cecilia GuzmanTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On May 3, 2024 at 1:15 PM , Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Annual Random inspection at the above Family Child Care Home (FCCH). LPA met with Licensee, Cecilia Guzman, and Assistant Nancy Alonso Esquivel. LPA discussed the purpose of the inspection. The FCCH operates Monday to Friday from 7:30 AM to 5:15 PM.

During the inspection, LPA and Licensee toured the inside and outside of the home. LPA observed 9 children playing under the care of 2 staff while 1 infant was napping in the bedroom. The required licensing forms were posted at the day care area. FCCH was free of hazardous items at the time of the inspection. FCCH utilizes living room, 1 bedroom, 1 bathroom, dining room, kitchen and converted garage (into day care area).The converted garage serves as a space for additional day care activities like coloring, reading and other outdoor activities that cannot be conducted outside during rainy weather. The backyard is enclosed by 8-foot hollow block and wood fencing. The surface, covered with grass and concrete, is hazard-free, and the concrete side of the play area is shaded.

Bathroom for children’s use is free of toxins. Smoke and carbon monoxide detectors were observed. The regulation fire extinguisher was purchased 10/28/2023. Age-appropriate toys, book, and equipment were observed inside the home. LPA did not observe any bodies of water. Licensee stated there are no guns or ammunition in the home.
Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216193
VISIT DATE: 05/03/2024
NARRATIVE
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 LPA reviewed the facility file and found that the Pediatric CPR and First Aid certificate expires on 8/24/2025 while Mandated Reporter Training Certificate expires on 8/25/2025. LPA reminded Licensee of the said certificates to be renewed every two years. Children's records were reviewed and found complete. Licensee stated that she does not have current liability insurance for her FCCH. LIC 282, notifying parents that FCCH does not carry liability insurance is on file.

Licensee checks and logs sleeping infant every 15 minutes. The Individual Safe Sleep Plan was filled out for infants 0-12 months old. FCCH conducted and logged the fire and disaster drill on 4/22/2024 and is conducting it every month. Control of Property was also reviewed.

During the facility roster review, it was observed that Licensee’s adult child, Camila Guzman Herrera turned 18 years old on 2022 and has no criminal record clearance. Ms. Guzman obtained criminal record check on 12/22/2022, however, due to incomplete information on LIC 9163, Request for Live Scan Service, an action required notice was sent to the applicant by California Department of Social Services (CDSS), Care Provider Management Bureau (CPMB) which was not fulfilled in a timely manner and as a result the case was closed.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

Continued on LIC 809C

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

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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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: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216193
VISIT DATE: 05/03/2024
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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/inspection-process.

Licensee, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Cecilia Guzman 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, Cecilia Guzman 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Continued LIC 809C.

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

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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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: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216193
VISIT DATE: 05/03/2024
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Licensee, Cecilia Guzman was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, Cecilia Guzman confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today's inspection, Type A deficiency was cited under Title 22 Division 12. and Health and Safety Code.



LPA Reyes informed licensee, Cecilia Guzman that this report dated 5/3/2024 documents one (1) Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.
Also, LPA Reyes informed the licensee, Ms. Cecilia Guzman to provide a copy of this licensing report dated 5/3/2024 that documents any Type A citation 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.

A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee, Cecilia Guzman

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

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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Document Has Been Signed on 05/06/2024 08:11 AM - It Cannot Be Edited


Created By: Gigi Reyes On 05/03/2024 at 03:52 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: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 426216193

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above License's daughter, Camilla Herrera Guzman turned 18 years old on 12/12/2022 does not have criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care. Ms. Guzman applied for criminal record check on 12/22/2022, however, LIC 9163 (Request for Live Scan form) was incomplete and applicant failed to submit the (LIC508) documentation required by Care Provider's Management Bureau. A $500 civil penalty was assessed.
POC Due Date: 05/06/2024
Plan of Correction
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Licensee agreed to have her adult child Ms. Guzman to re apply for criminal record check by Monday, 5/6/2024 and submit a written plan of correction on how to prevent the same incident from occurring. POC shall be submitted to CCL no later than 5/6/2024. gigi.reyes@dss.ca.gov
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: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2024


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