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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216426
Report Date: 12/12/2024
Date Signed: 12/12/2024 04:03:08 PM

Document Has Been Signed on 12/12/2024 04:03 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:SILVA MEDINA FAMILY CHILD CAREFACILITY NUMBER:
426216426
ADMINISTRATOR/
DIRECTOR:		ELIZABETH SILVA MEDINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 201-8992
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
12/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Elizabeth SilvaTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 12/4/2024, at 1:30 PM, Licensing Program Analyst (LPA) Gigi conducted an unannounced Annual Random inspection at the above Family Childcare Home (FCCH). LPA met with Licensee, Elizabeth and discussed the purpose of the inspection. The FCCH operates Monday to Friday from 5:00 AM to 11:00 PM. FCCH caters to families by offering a flexible hours, such as night time care for parents working overnight shifts. However, FCCH does not operate on a 24-hour basis. FCCH provides care for children aged 2 to 13 years old.

During the inspection, LPA and Licensee toured the inside and outside of the home.. LPA observed 7 children, 6 of whom were napping. Around 2:30 PM 2 school age children were dropped off the FCCH. LPA observed required forms are posted in the prominent location Accessible areas are one bedroom for play and napping activities, hallway bathroom, dining room, fenced backyard. There were changes in the accessible and off-limit areas as notified by Licensee on 11/9/2024. One bedroom was made accessible to children, the living room, previously accessible to children is now designated as off limit, due to the set up of Christmas tree and ornaments. Other off limit areas are kitchen, 3 bedrooms and formal dining area which are barricaded with baby gate and retractable gate to restrict the access. New facility sketch was provided to the department on 11/27/2024.

Continued LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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: SILVA MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 426216426
VISIT DATE: 12/12/2024
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LPA reviewed the facility file and found that the Pediatric CPR and First Aid certificate expires on 9/8/2026, while Mandated Reporter Training Certificate expires on 11/19/2025. LPA reminded Licensee to renew the required training every two years.

LPA reviewed children’s files and found complete. FCCH conducts fire and disaster drill every 6 months and last drill was conducted on 8/25/2024.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Continued LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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: SILVA MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 426216426
VISIT DATE: 12/12/2024
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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 additional resource.

LPA also informed licensee, 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

During the exit interview, the LICENSEE, Elizabeth Silva Medina confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today's inspection, no deficiency was cited. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.


The inspection was conducted and translated in Spanish with the assistance of Jennifer Silva, report was translated in Spanish using the Spanish translator application format and Focus Language International, Inc.

Exit interview conducted and report was reviewed with the licensee, Elizabeth Silva Medina

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC809 (FAS) - (06/04)
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