426216524-12-18-2023-17-CC-FVEZ-CYMVRB-20231218153941

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216524
Report Date: 12/18/2023
Date Signed: 12/18/2023 03:39:53 PM

Document Has Been Signed on 12/18/2023 03:39 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:	MOTA GARCIA		FACILITY NUMBER:	426216524
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/18/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:09 PM
MET WITH:	Angelica Mota Garcia		TIME COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/18/23, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection and met with Applicant, Angelica Mota Garcia. LPA informed Applicant of the nature and purpose of the inspection. The applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 5:00 AM to 6:00 PM, Monday- Friday, and 5:00 AM to 5:00 PM on Saturday. The applicant also informed LPA of the intention to provide care for children 2 years to 12 years of age. Applicant was informed changes in licensing hours and/or the ages of children supervised and cared for can be altered upon notifying CCLD in writing of the given modifications and/or changes. The applicant reports there are four (4) adults that live in the home and four (4) adults have receive criminal record clearance. LPA toured the interior and exterior of the residence with the Applicant. This is a single-story home that consists of four (4) bedrooms, two (2) bathrooms, living room, dining area, kitchen, garage, and outdoor yard. Applicant reported day care services will occur in the living room, dining area, kitchen, and one (1) bathroom. Meanwhile, four (4) bedrooms, one (1) bathroom, garage and outdoor yard will be inaccessible to children in care. Applicant reported she will make some changes to her outdoor yard prior to it being accessible to children. Applicant understands that CCLD will need to inspect the outdoor yard before it is assessable to children in care. LPA observed all bedroom door to have door safety knobs and observed. In addition, the door that leads to the outdoor yard was observed to have a door safety knob. Lastly, the garage was found to be locked during this inspection. LPA observed that the living room, dining room, kitchen and one (1) bathroom have plenty of spacing and ventilation for the comfort of children in care. LPA observed an open face heater that will be covered with magnetic covers. LPA observed sharps are stored in an elevated cabinet in the kitchen. Medications were observed in a closet in the hallway of the home that is elevated. Cleaning compounds were observed on top of the refrigerator and in the laundry shed that is in the outdoor yard. The bathroom that will be used by children was observed to be clean and free of toxins. LPA observed items, equipment, toys, and furnishings for the children in care that are in good condition and age appropriate. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

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: MOTA GARCIA	FACILITY NUMBER: 426216524
	VISIT DATE: 12/18/2023

NARRATIVE

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LPA observed a required fire extinguisher (2A10BC) in the home which was purchased on 1/3/23. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a combination smoke and carbon monoxide detector that was tested at 1:45 PM and was operable.
LPA and applicant toured the outdoor yard. LPA observed the outdoor yard to be completely fenced and the exit gates are secured. Applicant reported that the outdoor yard will not be accessible until changes are made. Applicant understands that outdoor yard needs to be inspected prior to be accessible to children in care. Applicant reported filtered water will be accessible by means of jugs of filter water and individual cups for each child. LPA notes no bodies of water were observed. Applicant reported there are no guns and ammo in the home.

LPA's record review revealed Applicant completed Preventative Health training on 11/17/22. Further, Applicant completed Mandated Reporter training on 10/25/22 and Pediatric CPR/First Aid (EMSA approved) on 10/24/22. Applicant completed FCCH orientation on 10/4/22. LPA reminded Applicant of obligation to maintain current training and certifications. Applicant does not have liability insurance for the license as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).

Applicant 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, 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.

LPA notes that when Applicant submitted her application, Applicant reported five (5) adults lived in the home. Since one (1) adult no longer lives in the home. Applicant submitted proof of rental agreement for adult that no longer lives in the home and understands this adult may not be present during hours of operation.

Applicant rents/leases the home and does not have landlord consent. The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 children.

CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

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: MOTA GARCIA	FACILITY NUMBER: 426216524
	VISIT DATE: 12/18/2023

NARRATIVE

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If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children.

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) or (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.

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. Entrance Checklist was provided to the applicant.

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.

On this date, 12/18/23, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant, informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

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: MOTA GARCIA	FACILITY NUMBER: 426216524
	VISIT DATE: 12/18/2023

NARRATIVE

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A notice of site visit was given to applicant, and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant, Angelica Mota Garcia in Spanish.

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 platforms. 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.

The home meets Title 22 of CCR requirements for a Small Family Child Care license, effective today. Effective day of license is 12/18/23.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC809 (FAS) - (06/04)

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