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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216268
Report Date: 12/06/2023
Date Signed: 12/06/2023 11:18:34 AM

Document Has Been Signed on 12/06/2023 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:HURTADO FAMILY CHILD CAREFACILITY NUMBER:
426216268
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
12/06/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Angelica Hurtado AlejandreTIME COMPLETED:
11:30 AM
NARRATIVE
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On 12/6/23 at 9:15 AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Case Management- Change of Capacity inspection at the Hurtado Family Child Care Home (FCCH). LPA met with Angelica Hurtado Alejandre, Licensee, and Jesus Medina Guerrero, Assistant of the FCCH. The purpose of the inspection was explained. LPA observed three (3) children in care at the time of the inspection.

LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins which would pose a danger to the children in care.

LPA reviewed Licensee’s First Aid/CPR certification (EMSA approved) which was found to be current until 4/9/2025. LPA reviewed the Licensee’s Mandated Reporter Training certification which was found to be current until 12/30/2024. LPA observed a regulation fire extinguisher which was last serviced on 07/27/2022.

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.

This report continues on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
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: HURTADO FAMILY CHILD CARE
FACILITY NUMBER: 426216268
VISIT DATE: 12/06/2023
NARRATIVE
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LPA 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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 Angelica Hurtado Alejandre, licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The Licensee submitted documentation for a FCCH change of capacity to the Department in October 2, 2023. The Licensee is seeking to change the FCCH’s capacity from eight (Small FCCH) to fourteen (Large FCCH). On 11/6/2023, the Department received a fire inspection clearance form from the City of Guadalupe Department for a capacity of fourteen. As such the FCCH's change of capacity to 14 is granted on the present, 12/6/2023.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Angelica Hurtado Alejandre, Licensee. Today's inspection was conducted in Spanish by LPA Jimenez. Today, deficiency cited under Title 22 Division 12 Appeal rights given.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
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Document Has Been Signed on 12/06/2023 11:18 AM - It Cannot Be Edited


Created By: Martina Jimenez On 12/06/2023 at 10:41 AM
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: HURTADO FAMILY CHILD CARE
FACILITY NUMBER: 426216268

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/13/2023
Section Cited
CCR
102417(g)(1)

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The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
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Licensee agrees to submit verification of purchase or service fire extinguisher to CCLD by 12/13 2023, via email to LPA at: Martina.Jimenz@dss.ca.gov
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This evidence is met by..Licensee last service date of fire extinguisher was 7/27/2022. This posses a potential Health & Safety Risk to 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:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023


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