426216351-2-6-2023-17-CC-GRES-CNSQKE-20230206111414

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216351
Report Date: 02/06/2023
Date Signed: 02/06/2023 11:14:33 AM

Document Has Been Signed on 02/06/2023 11:14 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:	NEVAREZ FAMILY CHILD CARE		FACILITY NUMBER:	426216351
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	02/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Valerie Muniz-Nevarez		TIME COMPLETED:	11:20 AM

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 February 6, 2023, at 9:05 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced pre-licensing inspection and met with Applicant, Valerie Nevarez and her husband, Jose Nevarez. LPA asked pre screening questions related to COVID-19, applicant's responses indicate there are no COVID-19 exposure on site. LPA discussed the purpose of the inspection. The Family Child Care Home hours of operation will be Monday to Friday from 6:00 PM to 6:AM. Applicant will provide only a night time care. LPA in the company of the applicant toured the home inside and outside. This is a two story home composed of 4 bedrooms and 31/2 baths. Areas accessible to children will be the living room, dining, hallway, bathroom, and the backyard. Off limit areas are the 2nd floor and all the bedrooms, kitchen and garage. Staircase and kitchen areas have barricades making them inaccessible to children. LPA observed age appropriate toys, equipment and cots. Kitchen cabinets have plastic latches. The 2A10 BC fire extinguisher was serviced on 6/25/2023. The dual carbon monoxide and smoke detector was tested and found to be functional. Hazardous items are kept inaccessible to children in care. LPA did not observe any bodies of water. Applicant stated there are no guns and ammunition in the home which are stored and locked separately. The back yard is enclosed with a wooden fence. The elevated deck with 8-step stair case will be barricaded at the bottom. The Control of property was reviewed. Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

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: NEVAREZ FAMILY CHILD CARE	FACILITY NUMBER: 426216351
	VISIT DATE: 02/06/2023

NARRATIVE

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Applicant completed the Family Child Care orientation on 12/28/2021, Preventative Health and Safety Training was completed on 5/12/2022. Pediatric 1st Aid/CPR certificate expires on 1/8/2024. Mandated Reporter Training expires on 2/23/2024. Applicant was reminded that AB 1207 and Pediatric CPR should be renewed every 2 years. Applicant stated she does not have liability insurance at this time. LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, Measles, including verification of TB. Applicant's verification is on file.
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, 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

LPA discussed the California Code of Regulations, Title 22, Section 102426 Overnight Care with the applicant .

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. Children's record keeping requirements were reviewed.

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

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: NEVAREZ FAMILY CHILD CARE	FACILITY NUMBER: 426216351
	VISIT DATE: 02/06/2023

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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 until the following are completed.

- Applicant will place a barricade in the wooden deck stair case located in the backyard.
- Applicant will place a barricade/fence in the backyard to separate the accessible backyard from the off limit area in the yard.

Notice of Site Visit was issued, The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Appeal Rights were given and explained.

Exit interview conducted and report was reviewed with the applicant, Valerie Nevarez.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

LIC809 (FAS) - (06/04)

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