426216247-12-21-2022-17-CC-EBAY-CMBQM2-20221221111650

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216247
Report Date: 12/21/2022
Date Signed: 12/21/2022 11:18:07 AM

Document Has Been Signed on 12/21/2022 11:18 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:	CERVANTES FAMILY CHILD CARE		FACILITY NUMBER:	426216247
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/21/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Engracia Cervantes		TIME COMPLETED:	11:30 AM

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 12/20/22, at 8:00 AM, Licensing Program Analysts (LPA) Elvin Baddley conducted an announced Prelicense Inspection of the abovementioned residence and met with Applicant Engracia Cervantes. LPA informed Applicant of the nature and purpose of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 6:00 AM to 4:00 PM, Monday- Friday. The Applicant also Informed LPA of the intention to provide care for children 3 years of age to 12 years of age. LPA notes no children are in care at the time of the inspection. LPA toured the interior and exterior of the residence with the Applicant The residence is a three bedroom, three bathroom single story dwelling. The home's family room, living room, dinning room and bathroom (adjacent to dinning room) will be used for child care services, while the bedrooms and the remainder of the home will be excluded from care. LPA observed the home to be clean and orderly. The home has spacing and ventilation for children in care. The home's fireplace is screened by a metal screen. The bathroom to be used for children care is observed to be clean and free of toxins. Medication in the home is located in the master bedroom which is excluded from care. Cleaning compounds are located in a secure cabinet underneath the kitchen sink and in an elevated cabinet in the laundry room. Sharps are observed in an evaluated kitchen cabinet which will be beyond the reach of children in care. LPA observed a fire extinguisher (3A10BC) in the home which was purchased on 12/15/22. The fire extinguisher is lager than the regulation, but acceptable. LPA reminded Licensee of the responsibility to service or purchase a regulation fire extinguisher annually. The home has numerous smoke and carbon monoxide detectors. A smoke detector was tested at 8:40 AM and found to be operable. Likewise, a carbon monoxide detector was tested at 8:41 AM and found to be operable. (CONT. LIC 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

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: CERVANTES FAMILY CHILD CARE	FACILITY NUMBER: 426216247
	VISIT DATE: 12/21/2022

NARRATIVE

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The backyard is excluded from care. The Applicant updated the facility sketch. The Applicant informed LPA of the intention to take children in care to a neighboring park (Joe White Park) for outdoor activities which is two blocks form the home. The Applicant is reminded to ensure children are in consistent direct supervision when engaged in activities at the park and the children access age appropriate play equipment. LPA observed no bodies of water on site.

LPA record review revealed Applicant completed Preventative Health training on 1/20/22. Further, Applicant completed Mandated Reporter training on 1/9/22 and Pediatric CPR/First Aid (EMSA approved) on 6/17/21. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant control of property documents. Applicant does not have liability insurance for the home. LPA provided the Applicant LIC 282 form retaining to the aforementioned. Applicant informed no firearm or ammunition are on site.

LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPAs 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 (CONT.LIC 809-C Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

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: CERVANTES FAMILY CHILD CARE	FACILITY NUMBER: 426216247
	VISIT DATE: 12/21/2022

NARRATIVE

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an additional resource.

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant Engracia Cervantes. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 12/21/22.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC809 (FAS) - (06/04)

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