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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216260
Report Date: 03/28/2022
Date Signed: 03/28/2022 11:46:25 AM

Document Has Been Signed on 03/28/2022 11:46 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:VARGAS ALVAREZ FAMILY CHILD CAREFACILITY NUMBER:
426216260
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
03/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Claudia VargasTIME COMPLETED:
11:45 AM
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On March 28, 2022, at 9:00 Licensing Program Analyst (LPA) Gigi Reyes conducted an announced pre licensing inspection and met with applicant, Ms. Claudia Vargas. LPA asked pre screening questions related to COVID-19, applicant responses indicate there are no COVID-19 exposures on site. LPA discussed with applicant the purpose of the inspection. Applicant's 2 children and spouse were also present during the inspection.

The entire home was toured inside and outside. This is a single home composed of 3 bedrooms, two baths, living room, family room, kitchen, garage and backyard. Living room, one bathroom and backyard will be used for day care. The backyard is enclosed with fence separating the outside play yard from the entire backyard. Beyond the enclosure, there are chicken and birds and rabbits in the cage which are off limits The off limit areas of the home are the three bedrooms, one bathroom, family room, kitchen, dining area which are separated with baby gates making the areas inaccessible to day care children. The garage door is locked with child safety lock and a slide lock on top of the door. LPA observed age appropriate toys and books in the day care area. LPA did not observe any bodies of water. Applicant stated there are no guns or ammunition in the home. . There is a 2A10 BC Fire Extinguisher which was purchased on 3/7/2022.. Applicant is reminded to service or purchase the fire extinguisher every year. There is a carbon monoxide and smoke detector which were tested and found to be functional.

Ms. Vargas completed the Orientation on 10/28/2021, Preventative Health and Safety training was completed on 11/5/2021. Pediatric 1st Aid/CPR certificate expires on 1/22/2024. The control of property was reviewed and on file.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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: VARGAS ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 426216260
VISIT DATE: 03/28/2022
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Children's record keeping requirements were reviewed. Applicant stated she does not have liability insurance at this time. Ms. Vargas completed the Child Abuse Mandated Reporter Training on 1/6/2022 and is required to be completed every two years. LPA discussed COVID-19 Self Assessment and provided applicant the COVID -19 resources.
LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, Measles, including verification of TB. Verification is on file for applicant. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or sign a statement declining the influenza vaccine.

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

LPA discussed the safe sleep regulations with [applicant, licensee, or facility representative] 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 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.

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.

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

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
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: VARGAS ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 426216260
VISIT DATE: 03/28/2022
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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 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.

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.

Issuance of Small Family Child Care Home is pending subject for approval.

Exit interview conducted and report was reviewed with applicant, Claudia Vargas.

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

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
LIC809 (FAS) - (06/04)
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