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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216596
Report Date: 11/20/2023
Date Signed: 11/21/2023 10:36:07 AM

Document Has Been Signed on 11/21/2023 10:36 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:GARCIA FCCHFACILITY NUMBER:
426216596
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/20/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Guadalupe GarciaTIME COMPLETED:
01:45 PM
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On 11/20/23, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection and met with Applicant, Guadalupe 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 12:00 AM to 11:59 PM, Monday- Sunday. The applicant also informed LPA of the intention to provide care for children 6 months to 12 years of age. The applicant reported there are seven (7) adults that live in the home and seven (7) adults have receive 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, small open room, playroom, living room, dining area, kitchen, laundry room, garage, outdoor yard and outdoor studio. The applicant reported day care services will occur in the playroom, living room, one (1) bathroom, and outdoor yard will be accessible to children in care. Meanwhile four (4) bedrooms, two (2) bathrooms, laundry room, garage and outdoor studio will be inaccessible to children in care. LPA observed one secured gate making the small open room inaccessible to children in care. LPA notes this room is used as a nail tech room for Applicant’s adult child. LPA observed a secured gate making the kitchen inaccessible to children in care. Applicant reports that children will be allowed in the kitchen with supervision of an adult. LPA observed a secured gate on the first step of the stairway making the entire second floor inaccessible to children in care. LPA observed the outdoor yard is separated by means of a gate. LPA observed the outdoor studio consists of a small living room, kitchenette, and bathroom and studio is inaccessible to children in care. Lastly, LPA observed the garage was locked and secured. LPA observed the sides of the outdoor yard are made inaccessible by fencing.

LPA observed playroom, living room, one (1) bathroom, and the outdoor yard have plenty of spacing and ventilation for the comfort of children in care. LPA observed a fireplace in the living room that is made inaccessible by means of a large piece of furniture. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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: GARCIA FCCH
FACILITY NUMBER: 426216596
VISIT DATE: 11/20/2023
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LPA observed sharps are stored in an elevated cabinet in the kitchen. Medication for the family is stored in a separate elevated cabinet in the kitchen. Cleaning compounds were observed to be stored in the laundry room and in a locked cabinet under the sink in the kitchen. LPA notes all these areas are inaccessible to children in care. The bathroom of the FCCH is 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.

LPA observed a required fire extinguisher (2A10BC) in the home which was purchased on 11/2/23. 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 12:00 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. LPA observed there is plenty of shading. LPA and applicant discussed active supervision when children are playing in the outdoor yard. LPA observed a gate that separates the outdoor yard. LPA observed a locked garage and outdoor studio. Applicant reported filtered water will be accessible by means of water bottles and individual water cups. LPA notes no bodies of water were observed. Per Applicant there are no guns or ammo in the home.

LPA's record review revealed Applicant completed Preventative Health training on 2/23/23. Further, Applicant completed Mandated Reporter training on 3/12/23 and Pediatric CPR/First Aid (EMSA approved) on 3/8/23. Applicant completed FCCH orientation on 1/20/23. 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.

The applicant rents the home and provided proof of control of property. Because the applicant, rents/leases the home, proof of landlord notification is required. CONT 809-C

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

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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: GARCIA FCCH
FACILITY NUMBER: 426216596
VISIT DATE: 11/20/2023
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The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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, 11/20/23, 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: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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: GARCIA FCCH
FACILITY NUMBER: 426216596
VISIT DATE: 11/20/2023
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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, Guadalupe Garcia

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 date of license is today 11/20/23.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC809 (FAS) - (06/04)
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