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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216422
Report Date: 01/26/2023
Date Signed: 01/26/2023 10:28:23 AM

Document Has Been Signed on 01/26/2023 10:28 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:VARGAS FAMILY CHILD CAREFACILITY NUMBER:
426216422
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/26/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Griselda VargasTIME COMPLETED:
10:30 AM
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On January 26, 2023 at 8:45 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced pre-licensing inspection and met with Applicant, Griselda Vargas. 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. Applicant's minor child was present during the inspection.

LPA in the company of the applicant toured the home inside and outside. This is a one story home composed of 3 bedrooms, 2 baths. Areas accessible to children will be the living room, kitchen, dining, hallway, bathroom, and the backyard. Off limit areas are 3 bedrooms, one bathroom and garage. LPA observed age appropriate toys, equipment and cots. Kitchen cabinets have plastic locks. The 2A10 BC fire extinguisher was purchased on 7/14/2022. Carbon monoxide and smoke detectors were tested and found to be functional. LPA did not observe any bodies of water. Applicant stated there are guns and ammunition in the home which are stored and locked separately. The back yard is enclosed with a wooden fence. Control of property was reviewed.

Applicant completed the Family Child Care orientation on 3/22/2022. Preventative Health and Safety Training was completed on 5/12/2022. Pediatric 1st Aid/CPR certificate expires on 3/2024. Mandated Reporter Training expires on 3/22//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.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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 2
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: VARGAS FAMILY CHILD CARE
FACILITY NUMBER: 426216422
VISIT DATE: 01/26/2023
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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 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.

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.

The small Family Child Care Home license is granted and is effective today 1/26/2023



Notice of Site Visit was issued. Appeal Rights were given and explained. Exit interview conducted and report was reviewed with the applicant, Griselda Vargas
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
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