426216555-8-28-2023-17-CC-FVEZ-CV5UZR-20230828160157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216555
Report Date: 08/28/2023
Date Signed: 08/28/2023 04:02:05 PM

Document Has Been Signed on 08/28/2023 04:02 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:	PINEDA-CORTEZ FCCH		FACILITY NUMBER:	426216555
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 2	DATE:	08/28/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:37 PM
MET WITH:	Brenda Pineda		TIME COMPLETED:	04:10 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 08/28/23, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection and met with Applicant, Brenda Pineda. LPA informed Applicant of the nature and purpose of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 05:00 AM to 4:30 PM, Monday- Friday. Applicant also informed LPA of the intention to provide care for children 0 months to 10 years of age. Per applicant, there are six (6) adults living in the home and all six (6) adults have received criminal record clearance. LPA toured the interior and exterior of the residence with the Applicant. This is a two-story home that consists of four (4) bedrooms, three (3) bathrooms, living room, kitchen, dining room, garage and outdoor playground. Applicant reported most day care services will occur in the living room, dining room, kitchen, bathroom, and outdoor playground. Meanwhile, the entire second floor that consists of four (4) bedrooms and two (2) bathrooms are not accessible by means of a gate on the first step of the stairway. In addition, the garage is also inaccessible by means of a door safety knob. LPA observed the living room, dining room and kitchen to have spacing and ventilation for the comfort of children in care. LPA observe a fireplace in the home that is accessible to children in care. LPA observed sharps are stored in a drawer without a lock in the kitchen. Applicant reported she will be moving the sharps to an elevated cabinet in the kitchen. During today’s inspection, applicant started moving sharps to elevated cabinet. Medication for the family is stored in an elevated cabinet in the kitchen and the bedrooms of the adults in the home. Cleaning compounds were observed to be stored under the sink of the kitchen with no lock and in the garage of the FCCH. LPA notes the garage is inaccessible to children in care. The bathroom of the FCCH is observed to be clean and free of toxins. LPA observed all items, equipment, toys and furnishings are in good conditions and age appropriate. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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: PINEDA-CORTEZ FCCH	FACILITY NUMBER: 426216555
	VISIT DATE: 08/28/2023

NARRATIVE

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LPA observed a required fire extinguisher (2A10BC) in the home which was purchased on 04/13/22 and has since expired. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a smoke detector which were tested at 2:50PM and found to be operable. Applicant does not have carbon monoxide detector that is operable.

LPA and applicant toured the outdoor playground. LPA observed hazardous items in the outdoor playground that are accessible to children in care. Applicant understands that these items must be removed and inaccessible to children in care. LPA and applicant discussed active supervision when children are outdoors. LPA and applicant discussed adding additional shading for children especially during the summer months. Per Applicant, she will be adding shading soon. Applicant will provide filtered water for children by means of individual water cups. LPA did not observe any bodies of water. Applicant reported no guns or ammunition are stored in the FCCH.

LPA's record review revealed Applicant completed Preventative Health training on 05/17/2023. Further, Applicant completed Mandated Reporter training on 10/03/2021 and Pediatric CPR/First Aid (EMSA approved) on 03/08/23. Applicant completed FCCH orientation on 05/05/2019. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (rental agreement). LPA notes applicant is current with all required immunizations. Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). LPA notes landlord signed LIC9149 allowing applicant to care for up to 8 children at once.

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.

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, 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 CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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: PINEDA-CORTEZ FCCH	FACILITY NUMBER: 426216555
	VISIT DATE: 08/28/2023

NARRATIVE

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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.

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.

The following must be correct prior to Family Child Care License being issued.

1. Ensure all cleaning compounds and toxins are inaccessible to children by means of safety locks or latches.

2. Operable carbon monoxide.

3. Current fire extinguisher.

4. Ensure fireplace in the living room is inaccessible to children in care.

5. Ensure hazardous items and toxins in the outdoor playground are inaccessible to children in care.

Exit interview conducted and report was reviewed with the Applicant, Brenda Pineda. The home does not meets Title 22 Division 12 requirements of a small FCCH license. Applicant will inform LPA when changes are made to set up a pre-licensing appointment.

This report was translated in Spanish by LPA Velazquez due to applicant being primary Spanish speaking.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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