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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216599
Report Date: 07/17/2023
Date Signed: 07/17/2023 10:28:47 AM

Document Has Been Signed on 07/17/2023 10:28 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:MARIN FCCFACILITY NUMBER:
426216599
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Guadalupe Marin CruzTIME COMPLETED:
10:45 AM
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On 7/17/23, at 8:30 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an announced Prelicense Inspection of the abovementioned home and met with Applicant Guadalupe Marin Cruz. 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 5:45 AM--5:00 PM, Monday- Friday. Applicant also intends to care for children 0 years of age to 17 years of age. LPA notes, no children are in care at the time of the inspection.

LPA, in the company of Applicant, toured the interior and exterior of the home, in its entirety. The home's living room, kitchen, dining room, hallway bathroom and backyard will be used for child care services, while the remainder of the home will be excluded. LPA observed a child safety gate at the hallway leading to the home's master bedroom and laundry room.

LPA observed the home to be clean and orderly. The home has spacing and ventilation for children in care. The home has a fireplace in the family room which is screened by glass. The hallway bathroom to be used for children in care is observed to be clean and free of toxins. Medication in the home is located in the master bedroom which is exclude from care and inaccessible to children. Sharps in the home are located on the shelf of an elevated kitchen cabinet which is secure. Cleaning compounds are secured in the home's laundry room which is excluded from care and underneath the kitchen sink in a secure cabinet. The home has toy which are appropriate for children of varied ages.

LPA observed a fire extinguisher (2A10BC) in the home which was purchased 4/14/23. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has numerous combination smoke/carbon monoxide detectors. A combination smoke/carbon monoxide detector was tested in the home's hallway at 8:45 AM and found to be operable.

The backyard is enclosed by cinder block and the footing in the area is made up of various surfaces. The backyard's entry/exit gates are secured. The backyard is partitioned to separate an area where trash cans are
(CONT. LIC 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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: MARIN FCC
FACILITY NUMBER: 426216599
VISIT DATE: 07/17/2023
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kept. The backyard is free of hazards. LPA observed no bodies of water on site.

LPA's record review revealed Applicants' Mandated Reporter training was completed on 3/16/23 (expiration 3/16/25), and Pediatric CPR/First Aid (EMSA approved) was completed on 3/19/23 (expiration 3/19/25). Applicant completed Preventative Health Training on 6/1/23. LPA reminded Applicant of obligation to maintain current training and certifications. The Applicant provided proof of control of property. Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Applicant informed LPA no ammunition or firearms are on site.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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.

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 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-andresources/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
(CONT. LIC 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
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: MARIN FCC
FACILITY NUMBER: 426216599
VISIT DATE: 07/17/2023
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purchased equipment.

On 4/11/23, 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 disclosure; 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 was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the Applicant Guadalupe Marin Cruz. The home meets Title 22 Division 12 requirements of a Small FCCH License (8). Effective date of license will be noted as the present, 7/17/23.

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-carelicensing/subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
LIC809 (FAS) - (06/04)
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