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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216561
Report Date: 05/24/2023
Date Signed: 05/24/2023 11:14:18 AM

Document Has Been Signed on 05/24/2023 11:14 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:SANTOSFACILITY NUMBER:
426216561
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/24/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dalia Lizbeth SantosTIME COMPLETED:
11:20 AM
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On 05/24/2023 at 9:00 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of residence and met with Applicant, Dalia Santos. LPA informed Applicant of the nature and purpose of the inspection. LPA notes there are no children present during this inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 03:00 AM to 5:00 PM, Monday- Friday and 03:00 AM- 2:00 PM, on Saturday. The Applicant also informed LPA of the intention to provide care for children 0 months to 12 years of age. There are four (4) adults that lives in the home and four (4) adults have received criminal record clearance.

LPA toured the interior and exterior of the residence with the Applicant. This is a single level home that consists of three (3) bedrooms, two (2) bathrooms, main living room, second living room that is located right when you enter the home, kitchen, dining area, garage, laundry room, and outdoor yard. Per applicant, children will have access to the main living room, kitchen, dining area, (1) bathroom, and part of the outdoor yard. Meanwhile, the second living room, three (3) bedrooms, one (1) bathroom, laundry room, garage, and part of the outdoor yard will be inaccessible to children in care. LPA observed door safety knob on the bedroom doors and garage door to ensure areas are made inaccessible. In addition, LPA observed a gate making the second living room inaccessible to children in care. Applicant reported that children will walk through the second living room to get to the on limits areas of the home and children will always be accompanied by an adult.

LPA observed the living room to have spacing and ventilation for children in care. LPA observed a fireplace in the main living room that is made inaccessible by means of a safety latch. LPA observed sharps are stored in an elevated cabinet in the kitchen. LPA observed medications for the applicant and her family are stored in the pantry in an elevated shelve. LPA observed cleaning compounds are stored in the laundry room in an elevated cabinet. LPA notes all areas are inaccessible to children in care. The bathroom of the FCCH is observed to be clean and free of toxins. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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: SANTOS
FACILITY NUMBER: 426216561
VISIT DATE: 05/24/2023
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 LPA observed safety latches on the bathroom cabinets and on the sliding door of the shower. LPA observed all items, equipment, toys and furnishings are in good conditions and age appropriate.

LPA observed a required fire extinguisher (2A10BC) in the home which was purchased on 05/24/2023. 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 which were tested at 10:10 AM and found to be operable.

LPA and applicant toured the outdoor yard. LPA observed the outdoor yard to be completely fenced. LPA observed children will have access to part of the outdoor. LPA observed a permanent fence separating the outdoor has been placed to ensure part of the outdoor yard is inaccessible to children in care. LPA observed exits are secured for the children in care. The outdoor yard consists of dirt and artificial grassing. LPA notes a canopy has been added for additional shading and has plenty of natural shading provided by the home. Filtered water will be provided to children in care by means of water dispenser and individual cups. LPA did not observe any bodies of water. Per applicant, no guns or ammo are stored on site.

LPA's record review revealed Applicant completed Preventative Health training on 06/21/2022. Further, Applicant completed Mandated Reporter training on 12/01/2022 and Pediatric CPR/First Aid (EMSA approved) on 01/14/2023. Applicant completed FCCH orientation on 01/01/2022. 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 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. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
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: SANTOS
FACILITY NUMBER: 426216561
VISIT DATE: 05/24/2023
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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.

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.

Exit interview conducted and report was reviewed with the Applicant, Dalia Santos. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 05/24/2023.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC809 (FAS) - (06/04)
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