426216423-10-13-2022-17-CC-FVEZ-CK76EQ-20221013204508

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216423
Report Date: 10/13/2022
Date Signed: 10/13/2022 08:45:30 PM

Document Has Been Signed on 10/13/2022 08:45 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:	GUZMAN FAMILY CHILD CARE		FACILITY NUMBER:	426216423
ADMINISTRATOR:	JESSICA GUZMAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 868-3877
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/13/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Jessica Guzman		TIME COMPLETED:	05:30 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 10/13/22, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of the abovementioned home and met with Applicant, Jessica Guzman. 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 7:30 AM to 5:30 PM. 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 single level home that consists of two (2) living rooms, dining room, kitchen, three (3) bedrooms, two (2) bathrooms, laundry room, two (2) garages and outdoor yard. The home will be using one (1) living room, bathroom, living room and outdoor yard for child care services. Off limit areas include, all three (3) bedrooms, one (1) bathroom, laundry room, garage that connects to the home and detached garage. LPA observed the living room to have ample spacing and ventilation for children in care. LPA observed a fireplace in the living room that is made inaccessible with a screen. The home's bathroom to be used for children care is observed to be clean and free of toxins. LPA observed sharps are stored in the kitchen counter. Medications are stored in an elevated cabinet in the hallway that is inaccessible to children in care. Cleaning compounds were observed in the laundry room that is also inaccessible to children in care. LPA observed a required fire extinguisher 2A10BC in the home which was purchased on 8/11/22. 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 4:30 PM and found to be operable. LPA observe the outdoor yard to be completely fenced. LPA observed the home provides natural shading. LPA observed a detached garage that is locked and inaccessible to children in care. All equipment and children items observed in the home are age appropriate and in good conditions. Applicant reported water will be accessible by individual water cups. LPA notes no bodies of water were observed. 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)

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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: GUZMAN FAMILY CHILD CARE	FACILITY NUMBER: 426216423
	VISIT DATE: 10/13/2022

NARRATIVE

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LPA record review revealed Applicant completed Preventative Health training on 1/20/22. Further, orientation was completed 2/20/22. Applicant completed Mandated Reporter training on 6/25/22, and Pediatric CPR/First Aid (EMSA approved) on 8/9/22. 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 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 9/28/22.

Applicant reports there are guns in the FCCH. LPA observed that guns are stored in the attached garage in a safe that requires a numerical code to open. LPA observed guns are locked an inaccessible to children in care. Per Applicant, there are no ammo stored in the FCCH.

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: 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: GUZMAN FAMILY CHILD CARE	FACILITY NUMBER: 426216423
	VISIT DATE: 10/13/2022

NARRATIVE

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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, Jessica Guzman. 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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