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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216477
Report Date: 06/06/2024
Date Signed: 06/19/2024 11:49:13 AM

Document Has Been Signed on 06/19/2024 11:49 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ASUAJE FAMILY CHILD CAREFACILITY NUMBER:
426216477
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
06/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Veronica AsuajeTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On 06/06/2024, at 2:30 PM, Licensing Program Analyst (LPA) S. Mendoza-Ceja conducted an unannounced Annual/Random Inspection. LPA met with Licensee Veronica Asuaje and explained the purpose of the inspection, also present was Alba Naicari Asuaje. LPA escorted LPA through the home inside and outside. The Family Child Care Home (FCCH) is a four bedroom home, two restrooms, living room, kitchen, dining room, garage and play area. Licensee stated there are no guns or ammunition in the facility or pools/bodies of water on the premises.

Upon arrival, LPA observed Licensee holding child #1 and the other seven (7) children were napping in the one bedroom. Licensee Veronica Asuaje and her assistant Alba Naicari Asuaje were caring for eight (8) children of which 5 were infants. Licensee stated her mother moved into the home approximately 2 months ago.

The children have been designated access to the living room which is set up with various toys and equipment, one bedroom, one restroom (hallway). The off limit areas include three bedrooms, one restroom (master), and garage.

LPA observed the off limits areas: two bedroom doors open and another bedroom door closed and accessible to day care children. In two of the bedrooms LPA observed over the counter medicines and vitamins accessible to day care children (picture). The kitchen was made inaccessible to day care children with mesh fencing/gates. The home was observed to be clean, and orderly, and has ventilation for children. The restroom designated for children was in safe and sanitary condition. Toys and equipment observed to be age appropriate.

LPA observed required licensing forms posted on the wall near the back entry door of the home where parents enter. LPA observed a smoke and carbon monoxide detectors in the home which was tested and operating.. There is a 2 A10BC fire extinguisher in the home. LPA did not observe any service tag. Licensee stated she had it serviced in 2022. LPA reminded Licensee the fire extinguisher needs to be either service or purchase annually. There is no fire place in the home.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Sylvia Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ASUAJE FAMILY CHILD CARE
FACILITY NUMBER: 426216477
VISIT DATE: 06/06/2024
NARRATIVE
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fencing/gates. The home was observed to be clean, and orderly, and has ventilation for children. The restroom designated for children was in safe and sanitary condition. Toys and equipment observed to be age appropriate.

LPA observed required licensing forms posted on the wall near the back entry door of the home where parents enter. LPA observed a smoke and carbon monoxide detectors in the home which was tested and operating.. There is a 2 A10BC fire extinguisher in the home. LPA did not observe any service tag. Licensee stated she had it serviced in 2022. LPA reminded Licensee the fire extinguisher needs to be either service or purchase annually. There is no fire place in the home.

The backyard is used for outdoor activities, is enclosed by fencing and the entry/exit gate. LPA observed various play equipment for children. No bodies of water were observed at the visit.

LPA reviewed the children's records and found the eight (8) children files were incomplete/missing documents, also missing was the Safe Sleep 15 minute check documentation for the five (5) infants (under age - 2) in care. Frequently asked Questions LPA reviewed and provided 102425 Infant Safe Sleep Regulations and the Safe Sleep- Frequently Asked Questions in Spanish/English which includes a 15 minute Infant Safe Sleep Chart.

Review of the Licensee's and her assistant's Alba Naicari Asuaje records reveal they are incomplete. Licensee Veronica Asuaje Mandated Reporter training certificate expired and her mother Alba Naicari Asuaje has not completed the training. LPA reminded Licensee that AB1207 must be updated every two years. Licensee and Alba Naicari Asuaje both are current CPR and First Aid certification (expires on 04/03/2026). Licensee did not have verification of Alba Naicari Asuaje TB, MMR, Tdap or Flu.

There was no emergency drill log available for review. LPA reminded Licensee that emergency drills are required every six months and need to be documented.

Licensee stated she does not offer Incidental Medical Services (IMS). 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/.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Sylvia Ceja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 06/19/2024 11:49 AM - It Cannot Be Edited


Created By: Sylvia Ceja On 06/07/2024 at 10:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ASUAJE FAMILY CHILD CARE
FACILITY NUMBER: 426216477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)&(e)
(d) (1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or criminal record exemption as required by the Department.
(e) Violation of Section 102370(d) will result in a citation of a deficiency and an immediate assessment of civil penalties of one hunred dollars ($100) per violation per day for a maximum of (5) days by the Deparment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with licensee, and record review, the licensee did not comply with the section cited above when she allowed Alba Naicari Asuaje to move into the home and assist in the day care prior to obtaining a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
Licensee is advised an Immediate Civil Penalty is assessed of $500.00.
POC Due Date: 06/11/2024
Plan of Correction
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Licensee shall ensure Alba Naicari Asuaje obtains a criminal record clearance.
Licensee shall submit a written plan of correction to Licensing for review by 06/11/2024.
Type A
Section Cited
CCR
102416.5(a)(b)12
Staffing Ratio and Capacity: (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. (b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (1)Four infants; or (2) Six children, no more than three of whom may be infants;

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with licensee and record review, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. Licensee and her assistant were providing care for eight (8) children of which five (5) were infants.
POC Due Date: 06/11/2024
Plan of Correction
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Please correct immediately. Submit a plan of correction to Licensing for review on how she will be in compliance.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Sylvia Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 06/19/2024 11:49 AM - It Cannot Be Edited


Created By: Sylvia Ceja On 06/07/2024 at 11:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ASUAJE FAMILY CHILD CARE
FACILITY NUMBER: 426216477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(1)&(4)
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (1) Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.



This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with licensee, and record review the licensee did not comply with the section cited above when the licensee did not secure/lock doors to off limits bedrooms which had vitmains and various over the counter medications which poses an immediate health, safety or personal rights risk to persons in care. In addition, licensee failed to have the 2 A10 BC Fire Extinguisher serviced as required.
POC Due Date: 06/11/2024
Plan of Correction
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Correct Immediately. Submit the written plan of correction to Licensing by 06/11/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Sylvia Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 06/19/2024 11:49 AM - It Cannot Be Edited


Created By: Sylvia Ceja On 06/07/2024 at 12:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ASUAJE FAMILY CHILD CARE
FACILITY NUMBER: 426216477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
102425 (j)(2)(D) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (D) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: a. Date. b. Infant’s name. c. Time of each 15-minute check.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with Licensee and record review, the licensee did not comply with the section cited above. Licensee failed to document and maintain records of the 15 Iminute infant sleep chart of the five (5) infants infants in care which poses/posed a potential health, safety or peonal rights risk to persons in care.
POC Due Date: 06/10/2024
Plan of Correction
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Please correct. Licensee shall submit a plan of correction to Licensing by 06/10/2024.
Type B
Section Cited
HSC
1597.622
1597.622 (a) (1) Employees or volunteers at family day care home; immunization requirements; records; exemptions (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with Licensee and record review, the licensee did not comply with the section cited above. Licensee failed to obtain verification of Alba Naicari Asuaje 's immunization against influenza, petussis, and measles which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2024
Plan of Correction
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Plese submit a plan of correction to Licensing for review by 06/11/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Sylvia Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 06/19/2024 11:49 AM - It Cannot Be Edited


Created By: Sylvia Ceja On 06/07/2024 at 01:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ASUAJE FAMILY CHILD CARE
FACILITY NUMBER: 426216477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102369(b)(9)
b (9) Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with Licensee and record review, the licensee did not comply with the section cited above. Licensee failed to obtain verification of a tuberculosis clearance for Alba Naicari Asuaje which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2024
Plan of Correction
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Please correct. Submit a written plan of correction to Licensing for review by 06/11/2024
Type B
Section Cited
HSC
1596.866(b)(1)
1596.8662(b)(1) Child Abuse Mandated Reporter Training
1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.



This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with Licensee, and record review, the licensee did not comply with the section cited above. It was found that Licensee's Child Abuse Mandated Reporter Training expired in 2023. Licensee's assistant Alba Naicari Asuaje has not completed the training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2024
Plan of Correction
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Please correct and submit verification to Licensing by 06/17/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Sylvia Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ASUAJE FAMILY CHILD CARE
FACILITY NUMBER: 426216477
VISIT DATE: 06/06/2024
NARRATIVE
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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.

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

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

Type A and B Deficiencies are being cited based on LPA observations pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D's). An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Licensee.

Licensee was provided a copy of their Appeal Rights (LIC 9058) and Notice of Site Visit form (LIC 9213). Notice of Site visit must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Veronica Asuaje.

Note: Report was translated in Spanish to Licensee and emailed for signature on 06/07/2024

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Sylvia Ceja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 06/19/2024 11:49 AM - It Cannot Be Edited


Created By: Sylvia Ceja On 06/07/2024 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ASUAJE FAMILY CHILD CARE
FACILITY NUMBER: 426216477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)9(A)1
g)((9) (A) (1) Each family childcare home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family childcare home shall conduct fire drills and disaster drills at least once every six months. 1.The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family childcare home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observed, interview with Licensee and record review, the licensee did not comply with the section cited above. Licensee failed to document the required emergency disaster drills as required which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2024
Plan of Correction
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Please correct and submit a plan of correction to ensure this violation is not repeated by 06/17/2024.
Type B
Section Cited
CCR
102421(a)
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with Licensee, and record review the licensee did not comply with the section cited above. Review of eight (8) children's files revealed the files were incomplete and missing documents which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2024
Plan of Correction
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Please correct and submit verification of completion to the Department by 06/17/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Sylvia Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


LIC809 (FAS) - (06/04)
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