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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216419
Report Date: 10/13/2022
Date Signed: 10/13/2022 08:24:07 PM

Document Has Been Signed on 10/13/2022 08:24 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:RUIZ FCC AKA RUIZ FAMILY DAYCAREFACILITY NUMBER:
426216419
ADMINISTRATOR:ANGELICA RUIZ,MARK NAVARREFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 598-9891
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Angelica RuizTIME COMPLETED:
01:15 PM
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On 10/13/22, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of the abovementioned home and met with Applicant, Angelica Ruiz. LPA informed Applicant of the nature and purpose of the inspection. LPA notes there are no children on site at the time of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from, Monday- Friday from 6:00 AM to 6:00PM. The Applicant also informed LPA of the intention to provide care for children birth to 12 years of age.

LPA toured the interior and exterior of the home with the Applicant. This is a two-story home; the second floor consists of one (1) loft with restroom. The bottom level consists of three (3) bedrooms, two (2) bathrooms, kitchen, dining room, living room, garage and outdoor yard. The home will be using, living room, dining area, kitchen, one (1) bedroom, bathroom, and outdoor yard. Off limit areas include the entire second floor, two (2) bedrooms, one (1) bathroom, and garage. LPA observed the living room to have ample spacing and ventilation for children in care. LPA observed a fireplace in the day-care room that is made inaccessible with a lock. The home's bathroom to be used for children care is observed to be clean and free of toxins. LPA observed sharps and medications are stored in an elevated cabinet in the kitchen that is inaccessible to children in care. Cleaning compounds were observed in the garage that is also inaccessible to children in care.

LPA observed a required fire extinguisher 2A10BC in the home which was purchased on 6/27/22. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has smoke and carbon monoxide detectors which were tested at 12:05 PM and found to be operable.

LPA observe the outdoor yard to be completely fenced. The facility has a front and back yard that are both completely fenced. LPA observed the home provides natural shading. Applicant notified LPA that a fence will be added to the outdoor yard to make part of the outdoor yard inaccessible to children in care. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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: RUIZ FCC AKA RUIZ FAMILY DAYCARE
FACILITY NUMBER: 426216419
VISIT DATE: 10/13/2022
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Applicant will update facility sketch and will notify the department once the fence has been placed. Applicant stated water will be accessible by individual cups. LPA notes no bodies of water were observed.

There are guns and ammo in the FCCH. LPA observed guns are stored in the Applicant's bedroom in a large safe. Bedroom is inaccessible to children in care. Safe requires a spin code to be able to open the safe. LPA observed guns with locks inside the safe. Ammunition is stored in the garage. LPA observed ammunition stored in a locked cabinet in the garage. Applicant understand that guns and ammo is required to be locked separately.

LPA record review revealed Applicant completed Preventative Health training on 7/29/22. Further, Applicant completed Mandated Reporter training on 6/8/22, and Pediatric CPR/First Aid (EMSA approved) on 8/7/22. 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 yet, but is planning on getting liability insurance soon. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Applicant received fire clearance for a large license from Santa Maria Fire Department on 9/15/22. There are three (3) adults living in the home. All three (3) adults are fingerprint cleared.



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. CONT 809-C

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

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
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: RUIZ FCC AKA RUIZ FAMILY DAYCARE
FACILITY NUMBER: 426216419
VISIT DATE: 10/13/2022
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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, Angleica Ruiz. The home meets Title 22 Division 12 requirements of a Large FCCH license. Effective date of license will be noted as the present, 10/13/22.

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

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC809 (FAS) - (06/04)
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