426216264-12-19-2023-17-CC-GNEE-CYNVUH-20231219154446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216264
Report Date: 12/20/2023
Date Signed: 12/19/2023 03:44:56 PM

Document Has Been Signed on 12/19/2023 03:44 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	FONSECA FAMILY CHILD CARE		FACILITY NUMBER:	426216264
ADMINISTRATOR:	YADIRA FONSECA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 757-1067
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 10	DATE:	12/20/2023
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	10:03 AM
MET WITH:	Yadira Fonseca		TIME COMPLETED:	04:00 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 12/19/2023 at 10:15AM, Licensing Program Analyst (LPA) German Negrete and Gigi Reyes conducted an unannounced Required Inspection. LPA met with Licensee, Yadira Fonseca and Assistant Gisel Miranda. The purpose of the visit was discussed with the Licensee and together we toured the inside and outside of the home. LPAs observed 7 children and 2 infants for a total of 9 at the time of the inspection.

LPAs Inspected the FCCH which is a two story home. The second floor is off limit to the children. The main day care areas are living room, dining room, kitchen, downstairs bathroom and backyard. LPAs observed age appropriate books, games, tables and chairs in the living room. LPAs observed the off-limits areas which include second floor, the two bedrooms and bathroom are secure with doorknob covers. Also there is a gate downstairs leading to the staircase that prevents second floor access to children in care.

During the inspection of the back yard LPAs inquired about rectangular Swing that was accessible to children in care. Licensee tied the swing to the wooden beam to make it inaccessible to children in care. The backyard is completely fenced. LPAs observed age appropriate toys, bikes, and other playhouses. LPAs toured the upstairs master bedrooom. LPAs observed a walk in closet in the master bedroom. The closet had clothing that belong to a male. The Licensee did not allow LPAs to photograph the clothing. According to the Licensee the clothing's belong to her minor child whose bedroom does not have a closet. Furthermore Licensees child's room was not available for inspection. According to the licensee there is only one adult living in the FCCH.

CONTINUES ON LIC 809C & LIC 809D

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German Negrete	TELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 426216264
	VISIT DATE: 12/20/2023

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

LPAs toured the upstairs master bedrooom. LPAs observed a walk in closet in the master bedroom. The closet had clothing that belong to a male. The Licensee did not allow LPAs to photograph the clothing. According to the Licensee the clothing's belong to her minor child whose bedroom does not have a closet. Furthermore Licensees child's room was not available for inspection. According to the licensee there is only one adult living in the FCCH.

No bodies of water were observed. Licensee stated, there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. Children's roster is incomplete, C8 was not listed and was missing enrollment date and parents acknowledgment receipt of parents licensing report. The fire extinguisher was observed and was serviced 02/01/2023. There is a functioning dual carbon monoxide detector and smoke alarm that meets statutory requirements, were tested at 11:01AM and functioning at the time of the visit. Licensee is current with her immunization required per SB 792. The last Safety drill was conducted on 11/05/2023. Licensee is current with CPR and First Aid which expires 01/01/2024. Licensee completed the Mandated Reporter Training that is required per AB 1207. Licensee assistant Isel Miranda had her mandated reporter training completed on 1/08/2022. Assistant also has her CPR and First Aid completed and needs to be renewed on 01/01/2024.

Licensee [or facility representative] 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.

Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: Continued on ON LIC 809C & LIC 809D

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: htttp://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German Negrete	TELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 12/19/2023 03:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 426216264
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(d)

Operation of A Family Child Care Home

(d) The home shall provide safe toys, play equipment and materials. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above in having one rectagler swing in the back yard which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2023
	Plan of Correction
1 2 3 4	The LPAs observed the licensee elevated the swingand attached to the play structure. Licensensee tangled the swing on the overhead wodden swing hanger in order to prevent access to children.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in one out of 9 children in care.C8 was not listed in the roster.The roster also has incomplete section pertaining to the facility number, date and names. Which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2023
	Plan of Correction
1 2 3 4	Licensee needs to input the required fields in the facility roster. Once the completed roster with the required information has been inputed the licensee will scan and email the document to Licensing Program Analyst: German.Negrete@dss.ca.gov

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: Ana Tolentino	TELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German Negrete	TELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 426216264
	VISIT DATE: 12/20/2023

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

LPAs discussed the safe sleep regulations with licensee 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 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.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line ahttps://www.cdss.ca.gov/inforesources/child-care-licensing

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS today,on 12/19/2023 deficiency cited under Title 22 Division 12 Appeal rights given.
Licensee [or facility representative] was reminded that all adults 18 and over, 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 Child Care Center. 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

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German Negrete	TELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FONSECA FAMILY CHILD CARE	FACILITY NUMBER: 426216264
	VISIT DATE: 12/20/2023

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

An exit interview was conducted with licensee and a copy of report was provided.

Notice of Site Visit (LIC 9213) posted during LPA inspection, and must remain posted for 30 consecutive days. Failure to maintain posting as required will result in a civil penalty of $100.00. 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 LIC 809 and LIC 809 D.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German Negrete	TELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5