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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216311
Report Date: 03/08/2024
Date Signed: 03/08/2024 01:54:58 PM

Document Has Been Signed on 03/08/2024 01:54 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:FERNANDEZ FAMILY CHILD CARE HOMEFACILITY NUMBER:
426216311
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
03/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Claudia FernandezTIME COMPLETED:
02:00 PM
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On 3/5/24, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Case Management inspection of the Family Child Care Home (FCCH) for a change of capacity. LPA met with Claudia Fernandez, Licensee of the FCCH and explained the nature/purpose of the inspection. LPA notes there were four (4) children present during this inspection being cared by licensee.

During this inspection, LPA and Licensee together toured the and interior and exterior of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins at the time of the visit. LPA observed a fireplace in the living room that is made inaccessible by means of a secured gate. LPA observed that sharps are in an elevated cabinet in the kitchen. Cleaning compounds were observed in the laundry room in elevated cabinets. Medication for the family is stored in the Licensee’s bedroom that is inaccessible to children in care.

LPA reviewed the Licensee’s First Aid/ CPR certification which was completed on 03/20/22. LPA reviewed the Licensee’s Mandated Reporter Training certificate, which was completed on 02/07/24. LPA observed a regulation fire extinguisher which was serviced on 5/30/23. LPA observed a combination smoke and carbon monoxide detector that was operable during inspection.

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 licensee has a fire inspection appointment with the Santa Maria Fire Department on 03/22/24. The licensee understands that the large license will be issued once the FCCH passes its inspection with the Santa Maria Fire Department.

CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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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: FERNANDEZ FAMILY CHILD CARE HOME
FACILITY NUMBER: 426216311
VISIT DATE: 03/08/2024
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The licensee rents the home and has landlord consent. Because the licensee rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

The home does not meet Title 22 of CCR requirements for a Large Family Child Care license. A fire clearance is pending prior to issuing a Large Family Child Care License. Once the Santa Maria Fire Department inspection is completed and passed, a large license will be issued. The licensee was given Notice of Site Visit (LIC 9213) to be posted.

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

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC809 (FAS) - (06/04)
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