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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216493
Report Date: 12/27/2022
Date Signed: 12/27/2022 11:22:55 AM

Document Has Been Signed on 12/27/2022 11:22 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:BARAJAS GONZALEZ-SILVA FCCFACILITY NUMBER:
426216493
ADMINISTRATOR:JESSICA BARAJAS, MARIO GONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 406-2775
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
12/27/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jessica and Mario Gonzalez-SilvaTIME COMPLETED:
11:30 AM
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On December 27, 2022, at 9:15AM Licensing Program Analyst (LPA) Gigi Reyes conducted an announced pre-licensing inspection and met with Applicants, Jessica Barajas Gonzalez-Silva and Mario Gonzalez-Silva. LPA asked pre screening questions related to COVID-19, applicants' responses indicate there are no COVID-19 exposure on site. LPA discussed the purpose of the inspection. Applicants' 3 own children were present during the inspection.

LPA in the company of the applicants toured the home inside and outside. The home is composed of 4 bed rooms, 2 baths, living room, dining room, kitchen, day care area, fenced backyard and garage. Areas accessible to children will be day care room, dining area, one (1) bedroom, one (1) bathroom and the enclosed portion of the backyard. Off limit areas are 3 bedrooms, kitchen, living room, the portion of the backyard and garage. LPA observed age appropriate toys, equipment, and cots. The 2A10 BC fire extinguisher was purchased on 9/2/2022. There are carbon monoxide and smoke detectors which were tested and found to be functional. Applicants stated there are no guns and ammunition in the home, nobodies of water was observed.

Applicants completed the Family Child Care orientation on 10/24/2022 and 10/27/2022. Preventative Health and Safety Training was completed on 11/17/2022. Pediatric 1st Aid/CPR certificate expires on 5/31/2023. Mandated Reporter Training Certificates will expire on 1/25/2024 and 11/21/2024 . Applicants stated they do not have liability insurance at this time. LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, Measles, including verification of TB. Applicant , Mario Gonzalez-Silva's immunization records are not on file.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: BARAJAS GONZALEZ-SILVA FCC
FACILITY NUMBER: 426216493
VISIT DATE: 12/27/2022
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LPA discussed COVID-19 Mitigation Plan/Self Assessment.
Applicants were 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

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. Children's record keeping requirements were reviewed.

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.

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.

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

DATE: 12/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: BARAJAS GONZALEZ-SILVA FCC
FACILITY NUMBER: 426216493
VISIT DATE: 12/27/2022
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Applicants were made aware that they can provide care for a maximum of 12 children. LPA discussed that landlord consent is required for capacity of more than 12 or up to 14 children. LPA provided the Regulations on 102416.5 Staffing Ratio and Capacity under Health and Safety Code section 1597.465 . Applicants stated they will provide care only for maximum of 12 children LPA reviewed the Control of Property.

Fire Safety Clearance was granted on 12/16/2022.

Issuance of Large License is pending for further review.

Notice of Site Visit was issued. Appeal Rights were given and explained.

Exit interview conducted and report was reviewed with the applicants, Jessica Barajas-Silva and Mario Gonzalez-Silva.

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

DATE: 12/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022
LIC809 (FAS) - (06/04)
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