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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216563
Report Date: 03/27/2023
Date Signed: 03/28/2023 11:44:00 AM


Document Has Been Signed on 03/28/2023 11:44 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:AYALA FCCHFACILITY NUMBER:
426216563
ADMINISTRATOR:GRISELDA AYALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 325-1236
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 0DATE:
03/27/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Griselda AyalaTIME COMPLETED:
01:30 PM
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On 3/27/23 at 11:00 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Prelicensing Inspection of the home and met with Applicant, Griselda Ayala. LPA informed Applicant of the nature and purpose of the inspection. LPA notes there are no children on site at the time of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from, Monday- Friday from 9:00 AM to 5:00 PM. The Applicant also Informed LPA of the intention to provide care for children from 6 weeks to 10 years of age.

LPA toured the interior and exterior of the home with the Applicant. This is a single level home with three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, family room, garage, and outdoor play yard. Applicant will be using the family room and bathroom for day care services. Applicant is planning on making some changes to the outdoor yard, so for the meantime the outdoor yard will be off-limits to children in care. Once the outdoor yard is complete applicant will notify us by updating facility sketch. Off limits areas include living room, dining room, kitchen, three (3) bedrooms, one (1) bathroom and garage. LPA observed door safety knobs on all bedroom doors, garage has three (3) locks and there is a baby gate separating the family room.

The FCCH has plenty spacing and ventilation for children in care. LPA observed two (2) fireplace that are made inaccessible by baby gates. The family room has plenty of room for children’s activities. The bathroom to be used for children care is observed to be clean and free of toxins with hand washing poster for children. LPA observed sharps are stored in an elevated cabinet in the kitchen that is inaccessible to children in care. Medication in the home is stored in another elevated cabinet in the kitchen. Cleaning compounds were observed in the garage. LPA observed all areas are inaccessible to children in care.

LPA observed a required fire extinguisher 2A10BC in the home which was serviced on 12/28/22. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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: AYALA FCCH
FACILITY NUMBER: 426216563
VISIT DATE: 03/27/2023
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The home has smoke and carbon monoxide detectors which were tested at 12:00 PM and found to be operable.

LPA observe the outdoor yard to be completely fenced. Per Applicant, children will not have access to the outdoor for the moment. Applicant reports that she would like to make changes to the outdoors before it is accessible to children in care. LPA advised Applicant to notify the department and submit updated facility sketch prior to making changes to the outdoor yard. Once the yard is ready, Applicant understands that an inspection will take place prior to adding the outdoor yard as an area that is accessible. LPA notes no bodies of water were observed. Per Applicant there are no guns or ammo in the home. Filtered water will be always accessible to children by means of individual water cups.

LPA record review revealed Applicant is registered to take Preventative Health training on April 11, 12 and 13, 2023. Further, Applicant completed Mandated Reporter training on 10/7/22, and Pediatric CPR/First Aid (EMSA approved) on 10/25/22. FCCH orientation was completed on 2/15/23. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (Mortgage deed). Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Applicant received fire clearance for a large FCCH license from Santa Maria Fire Department on 03/23/23.



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 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.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
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: AYALA FCCH
FACILITY NUMBER: 426216563
VISIT DATE: 03/27/2023
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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 was conducted with Applicant, Griselda Ayala. The home meets Title 22 of CCR requirements for a provisional Large Family Child Care license effective today. Effective date of license is today March 27, 2023. Applicant was provided with Notice of Site Visit which must remain posted for the next 30 days.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
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