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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216404
Report Date: 12/28/2023
Date Signed: 12/28/2023 03:04:37 PM

Document Has Been Signed on 12/28/2023 03:04 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:CUNA FCC AKA DRAGONFLY PLAY HOUSEFACILITY NUMBER:
426216404
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
12/28/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Juana CunaTIME COMPLETED:
03:25 PM
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On December 28, 2023, @ 1:40 PM, Licensing Program Analysts (LPAs) Martina Jimenez and Aaliyah Zendejas, conducted an unannounced Inspection for the purpose of performing a Case Management- Change of Capacity inspection. LPA met with Juana Cuna, Licensee. LPAs explained the nature/purpose of the inspection.

During this inspection, LPAs and Licensee together toured the interior and exterior of the FCCH. LPAs observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins at the time of the visit, which would pose a danger to the children in care. LPAs observed 4 children napping at the time of the inspection.

LPAs observed a regulation 2A10BC fire extinguisher in the FCCH which was serviced on September 6, 2023. Licensee is reminded to service or purchase the fire extinguisher yearly. Licensee stated the combination smoke and carbon monoxide detectors were tested on December 5, 2023, by the Santa Maria Fire Department, and were functioning at the time of the inspection. Licensee stated that there are no guns or ammunition in the home. Licensee stated she does not hold a foster family license.

CONTINUES ON LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
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: CUNA FCC AKA DRAGONFLY PLAY HOUSE
FACILITY NUMBER: 426216404
VISIT DATE: 12/28/2023
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The licensee Pediatric First Aid/CPR certificate is valid until July 9, 2024. Licensee's Mandated Reporter Training certificate is valid until July 6, 2024. The licensee, provided proof of control of property. Control of property was verified via receipt of lease agreement. Because the applicant, 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).

Applicant was informed of the MyChildCarePlan.org site, 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. 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 platforms. 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.

On September 13, 2023, 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 Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on December 5, 2023.

The home meets Title 22 of CCR provisional requirements for a Large Family Child Care license effective today. Effective date of license is today December 28, 2023. LPA provided the Licensee a Notice of Site Visit (LIC 9213) to be posted. Today's inspection was conducted in Spanish by LPA Jimenez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
LIC809 (FAS) - (06/04)
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