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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216477
Report Date: 11/18/2022
Date Signed: 11/18/2022 12:55:05 PM

Document Has Been Signed on 11/18/2022 12:55 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:ASUAJE FAMILY CHILD CAREFACILITY NUMBER:
426216477
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Veronica AsuajeTIME COMPLETED:
01:00 PM
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On November 18th, 2022 at 12:00PM, Licensing Program Analyst (LPA) Rosie Breault conducted an announced inspection for the purpose of performing a change of location. LPA asked licensee Pre-Screening questions related to COVID-19. Licensee stated no exposure on site.
LPA met with licensee Veronica Asuaje discussed the purpose of the inspection. Licensee currently holds a small family childcare home (FCCH) and requested licensure at a new home location. LPA and licensee together toured the interior and exterior of the home. All adults (2) two living in the home, licensee and husband are both fingerprint cleared. Per licensee, the operating hours will be Monday through Friday from 8:00AM-4:30PM.
This is a single-story home which consists of four (4) bedrooms, two (2) restrooms, one (1) living room, kitchen, dining room, garage, and outdoor play area.
At the time of the inspection there was no refrigerator present. Licensee recently moved into the home and it is being delivered tomorrow (11/19/2022). The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Licensee states no firearms, guns, or ammunition present in the home. First aid kit is available for use.
Licensee stated that children will have access to: living room, dining room, (1) one bedroom, (1) one bathroom, kitchen, and outdoor play area.
Off limit areas include: (3) three bedrooms, (1) bathroom (master), and garage.
There are age appropriate toys and napping equipment on the premises. Knives and kitchen compounds are locked and inaccessible. The outdoor area is completely fenced with a lock secured. LPA notes there is ample shade for children and no bodies of water are present.

CONTINUED ON LIC809C
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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: ASUAJE FAMILY CHILD CARE
FACILITY NUMBER: 426216477
VISIT DATE: 11/18/2022
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The regulation fire extinguisher was purchased 11/15/2022. Combination moke detector and carbon monoxide detector was tested at 12:22 PM and was functioning at the time of the inspection. Licensee has current Pediatric First Aid and CPR which expires 8/2023.
Licensee 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.
The home meets Title 22 Division 12 requirements of a small FCCH license.
Due to absence of refrigerator (to be delivered Saturday November 19th, 2022) licensure is PROVISIONAL pending documentation of installation of refrigerator.
An exit interview was conducted, report reviewed and provided to licensee.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC809 (FAS) - (06/04)
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