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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216247
Report Date: 03/27/2024
Date Signed: 03/27/2024 04:42:22 PM

Document Has Been Signed on 03/27/2024 04:42 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:CERVANTES FAMILY CHILD CARE AKA SUNSHINE TOTSFACILITY NUMBER:
426216247
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
03/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Engracia CervantesTIME COMPLETED:
04:50 PM
NARRATIVE
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On 3/27/24 at 10:35 AM, Licensing Program Analysts (LPAs) Francisca Velazquez and David Roman conducted an unannounced Case Management Licensee initiated inspection of the Family Child Care Home (FCCH) for a change of capacity. LPAs met with Engracia Cervantes, Licensee of the FCCH and explained the nature/purpose of the inspection. LPAs notes there were five (5) children present during this inspection being cared for by licensee and Volunteer (S2).

During this inspection, LPAs and Licensee together toured the interior and exterior of the FCCH.

At 11:09 AM, LPAs observed C5 in a play pen with boppy pillow and blanket. Additionally, C5 had a bottle and was self-feeding in the playpen.

At 11:15 AM, LPAs observed the door to the master bedroom to not have a lock and was accessible to children in care. While interviewing the licensee, it was disclosed that licensee and partner (A2) reside in this bedroom. LPAs note that A2 does not have criminal record clearance.

At 11:35 AM, LPAs observed the children bathroom to have hairspray, blow dryer with long wire, and hair dye accessible to children in care. At 11:36 AM, LPAs observed cleaning compounds on the kitchen counter and under the sink that did not have a lock. At 11:39 AM, LPAs observed the laundry room to be accessible to children in care and observed laundry detergent accessible to children in care. At 11:40 AM, LPAs observed the garage door to not have a lock. Inside the garage, LPAs observed chemicals, tools and vehicle equipment that could pose a danger to children in care.

At 11:46 AM, LPAs toured the outdoor yard that is identified as off-limits to children in care. LPAs observed play equipment in the outdoor yard. Licensee’s interview revealed that Licensee does use the outdoor yard. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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Document Has Been Signed on 03/27/2024 04:42 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 03/27/2024 at 03:09 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: CERVANTES FAMILY CHILD CARE AKA SUNSHINE TOTS
FACILITY NUMBER: 426216247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
03/28/2024
Section Cited
CCR
102370(d)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement was not met as evidenced by:
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Licensee agrees to ensure all adults residing in the home are fingerprint cleared prior to being present in the home. Additionally, Licensee will ensure A2 gets fingerprint cleared and is not in the FCCH until A2 is fingerprint cleared. Licensee will submit proof of correction by 3/28/24 via email to
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Licensee's interview revealed, Raul Betancourt (A2) does not have criminal record clearance and has been residing in the home for about 9 months. This is an immediate risk to the health, safety, and personal rights of children in care.
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Francisca.Velazquez@dss.ca.gov
Type A
03/29/2024
Section Cited
CCR102425(b)

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Cribs or play yards shall be free from all loose articles and objects. This is an immediate risk to the health, safety and personal rights of children in care.
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Licensee agrees to watch training videos on the CDSS website and submit a written statement of what Licensee's learned on safe sleep regulations by 3/28/24 via email to Francisca.Velazquez@dss.ca.gov
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At 11:09 AM, LPAs observed three cribs with blanks and pillows. Additionally, LPAs observed C5 in a crib with a large boppy pillow, blank and bottle. This is an immediate risk to the health, safety and personal rights of children in care.
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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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


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Document Has Been Signed on 03/27/2024 04:42 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 03/27/2024 at 03:25 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: CERVANTES FAMILY CHILD CARE AKA SUNSHINE TOTS
FACILITY NUMBER: 426216247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/28/2024
Section Cited
CCR
102417(g)(4)

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Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced:
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Licensee agrees to add door knobs, gates and security latches to all areas that have toxins or hazardous items in the FCCH. Licensee will submit photos that these areas are now inaccessible to children in care by 3/28/24 via email to Francisca.Velazquez@dss.ca.gov
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During tour of the FCCH, LPAs observed toxins in licensee's bedroom, children's bathroom, kitchen, laundry room and outdoor yard, all which are accessible to the children. This is an immediate threat to the health, safety and personal rights of children in care.
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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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


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Document Has Been Signed on 03/27/2024 04:42 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 03/27/2024 at 03:32 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: CERVANTES FAMILY CHILD CARE AKA SUNSHINE TOTS
FACILITY NUMBER: 426216247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2024
Section Cited
CCR
102421(a)

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The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement was not met as evidenced by:
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Licensee agrees to complete all children files with all required licensing documents and will submit proof by 4/3/24 via email to Francisca.Velazquez@dss.ca.gov
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Child record review revealed C1-C5 had incomplete files with C1 and C2 having yellow immunization cards and C3 having an immunization summary from the doctor. There were no there records in C1-C5 files. This is a potential risk to the health, safety and personal rights of children in care.
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Type B
04/03/2024
Section Cited
CCR102416.1(a)

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Personnel records shall be maintained on each employee and shall contain the following information: This requirement was not met as evidenced by:
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Licensee agrees to complete all staff files with all required licensing documents and will submit proof by 4/3/24 via email to Francisca.Velazquez@dss.ca.gov
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Staff file review found Licensee only had current First-Aid/CPR on file and S2 only had criminal record clearance letter. No other documents were available for review. This is a potential risk to the health, safety and personal rights of children in care.
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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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


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Document Has Been Signed on 03/27/2024 04:42 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 03/27/2024 at 03:38 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: CERVANTES FAMILY CHILD CARE AKA SUNSHINE TOTS
FACILITY NUMBER: 426216247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2024
Section Cited
CCR
102417(g)(8)

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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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Licensee agrees to document all enrolled children in LIC9040 and submit proof by 4/3/24 via email to Francisca.Veazquez@dss.ca.gov
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Record review and Licensee interview revealed the FCCH does not have a current facility roster available for review. This is a potential risk to the health, safety and personal rights of children in care.
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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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


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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: CERVANTES FAMILY CHILD CARE AKA SUNSHINE TOTS
FACILITY NUMBER: 426216247
VISIT DATE: 03/27/2024
NARRATIVE
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In the outdoor yard, LPAs observed 4 large bags of cans, gardening equipment, tools, and an open shed that contained various hazardous equipment.

LPAs observed that sharps are in an elevated cabinet in the kitchen. Medication for the family is stored in the Licensee’s bedroom.

At 12:15 PM, LPAs conducted children file reviews and found all children files were incomplete. LPAs file review found that C1 and C2 had a yellow immunization card on file. Additionally, C3 had a summary of immunizations on file. There were no other children’s documents on file for review.

At 12:25 PM, LPAs reviewed Licensee’s and S2 file. LPAs found that both staff files to be incomplete. LPAs record review of Licensee’s file found Licensee’s First Aid/ CPR certification which was current and completed on 1/8/23. The licensee’s Mandated Reporter Training certificate was taken on 1/9/22 and has expired. There were no other documents in the Licensee’s file for review. Record review of S2’s file contained verification of criminal record clearance and no other documents. At 12:25 PM, Licensee reported there is no facility roster for review.

LPAs observed a regulation fire extinguisher which was serviced on 2/14/24. LPAs observed a combination smoke and carbon monoxide detector that was tested at 4:00 PM and was operable. Per Licensee, there are no guns and ammo in the home.

The Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 3/21/24.

Today, deficiency cited under Title 22 Division 12 Appeal rights given. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report.

CONT 809-C

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

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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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: CERVANTES FAMILY CHILD CARE AKA SUNSHINE TOTS
FACILITY NUMBER: 426216247
VISIT DATE: 03/27/2024
NARRATIVE
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The home meets Title 22 of CCR requirements for a Large Family Child Care license effective today. Effective date of license is today 3/27/24. LPAs provided the Licensee a Notice of Site Visit (LIC 9213) to be posted.

Exit interview and review of this report was conducted with licensee, Engracia Cervantes.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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