<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216398
Report Date: 01/20/2023
Date Signed: 01/23/2023 08:30:46 AM

Document Has Been Signed on 01/23/2023 08:30 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:ROBLES FAMILY CHILD CAREFACILITY NUMBER:
426216398
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
01/20/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Eva RoblesTIME COMPLETED:
05:05 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 01/20/2023 at 3:00 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of the residence and met with Applicant, Eva Robles. LPA informed Applicant of the nature and purpose of the inspection. LPA notes Applicant’s two (2) biological children were present during this inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 12:00AM to 11:59PM, Monday- Saturday. The Applicant also Informed LPA of the intention to provide care for children 0 months to 12 years of age. There are three (3) adults that live in the home and all adults have received criminal record clearance.

LPA toured the interior and exterior of the residence with the Applicant. This is a single-story home that consists of three (3) bedrooms, two (2) bathrooms, living room, kitchen/dining room, garage, and outdoor yard. The home's living room, kitchen/dining room and bathroom will be used for childcare services, while three (3) bedrooms, one (1) bathroom and garage are inaccessible to children in care. LPA observed door safety knobs on all bedroom doors and in the garage, door ensuring rooms are inaccessible to children in care. LPA observed a fireplace in the living room that is secured by means of gate. The bathroom that will be used by children is observed to be clean and free of toxins. In the kitchen, LPA observed sharps are stored in an elevated cabinet in the kitchen. LPA observed medication in the home is stored in a closet in the hallway that is locked and secured. Cleaning compounds were observed in the garage and in the closet in the hallway, both areas are inaccessible to children in care.

LPA observed a required fire extinguisher (2A10BC) in the home which was purchased on 6/22/22. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a combination smoke and carbon monoxide detector which were not tested due to Applicant’s young child taking a nap during this inspection. Per Applicant, alarms were tested about two weeks ago. LPA notes flashing green light on combination smoke and carbon monoxide detector.
CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2023
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 3
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: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 426216398
VISIT DATE: 01/20/2023
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
LPA observed the outdoor yard is securely fenced. LPA observe one (1) shed in the outdoor yard that is locked and secured. LPA advised Applicant to ensure shed is always locked as it contains toxins. LPA observed there is plenty of shading for children in care. Filtered water will be made accessible by means of individual water cups. LPA and Applicant discussed active supervision when children are outdoors.

LPA record review revealed Applicant completed Preventative Health training on 7/29/22. Further, Applicant completed Mandated Reporter training on 6/12/22 and Pediatric CPR/First Aid (EMSA approved) on 6/12/22. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (mortgage deed). Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Per Applicant, there are no guns or ammunition in the home.

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.

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.

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.

CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 426216398
VISIT DATE: 01/20/2023
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
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.

Exit interview conducted and report was reviewed with the Applicant, Eva Robles. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 1/20/23.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3