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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216426
Report Date: 09/28/2022
Date Signed: 10/04/2022 12:19:03 PM

Document Has Been Signed on 10/04/2022 12:19 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
426216426
ADMINISTRATOR:ELIZABETH RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 201-8992
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elizabeth RodriguezTIME COMPLETED:
11:10 AM
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This is an amendment of the report dated 9/28/2022 to state that Santa Barbara County Superior Court issued a Decree changing name of the Licensee/applicant, per court order, Elizabeth Rodriguez is changed to Elizabeth Silva Medina.

This is a change of location, previous facility no. was 426215321
On 9/28/2022, at 9:00 AM, Licensing Program Analyst ((LPA) Gigi Reyes made an announced Prelicensing Inspection at the above home address and met with Applicant/Licensee, Ms. Elizabeth Rodriguez and her son Mario Gonzalez. LPA explained purpose inspection. There are no children on site at the time of the inspection. Operating hours is set to Monday to Friday, 5:00 AM to 6:00 PM and Saturday, 5:00 AM to 2:00 PM, and shall provide care for children 0 month to 12 years of age.

LPA and Applicant toured the interior and exterior of the home. The home is composed of four bedrooms, and two bathrooms. The family room, hallway bathroom, fenced backyard will be the accessible areas for child care services. The home's living room kitchen, garage and 4 bedrooms are excluded from child care. LPA observed age appropriate toys and equipment, there are cribs and cots for napping The home's bathroom to be used for children care is observed to be clean and free of toxins. Medication and first aid kit are stored in a locked cabinet inaccessible to children. The cleaning compounds, sharp items are stored inaccessible to children. It was observed that all cabinets and doors have child safety lock. The entrance to childcare area is at the right side of the property. Parents dropping off and picking up children will use the laundry room passage to enter the home. Laundry equipment was observed to be locked and applicant stated , laundry will not be done during day care hours. The backyard of the home is enclosed by wood fencing and bricks. The back yard play area is free of hazards. LPA observed no bodies of water in the home.

LPA observed the 2A10BC fire extinguisher was purchased on 7/26/2022 LPA reminded Applicant/Licensee to service or purchase a regulation fire extinguisher annually. The home has smoke and carbon monoxide detectors which were tested at 9:30 AM and found to be operable.
CONT LIC 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216426
VISIT DATE: 09/28/2022
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The Applicant/ Licensee stated no firearms and ammunition are on site.

Applicant /Licensee completed Preventative Health training on 8/26/2021, completed Mandated Reporter training on 9/9/2021, and Pediatric CPR/First Aid on 7/17/2022. LPA reviewed Licensee's control of property document.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, 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 Licensee 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 for additional resource. LPA also informed Licensee 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.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Applicant/Licensee, Elizabeth Rodriguez. Report was translated in Spanish by Applicant's/Licensee's son Mario Gonzalez



Fire safety inspection clearance was granted on 9/21/2022. Family Child Care Home meets the CCR Title 22 Division 12 for a large License in the new location. License is effective today, September 28, 2022.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
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