426216633-12-14-2023-17-CC-MJIZ-CYHUSM-20231214145034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216633
Report Date: 12/14/2023
Date Signed: 12/14/2023 02:50:41 PM

Document Has Been Signed on 12/14/2023 02:50 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:	DIAZ FCC		FACILITY NUMBER:	426216633
ADMINISTRATOR:	AIDE DIAZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 264-7354
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	12/14/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Aide Diaz		TIME COMPLETED:	03:15 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 12/14/2023, Licensing Program Analyst (LPA) Martina Jimenez conducted an announced Pre-licensing inspection for a large Family Child Care Home (FCCH) license. LPA met with Aide Diaz, Applicant. The purpose of the inspection was discussed and together LPA and applicant toured the inside and outside of the home. There were no children in care at the time of the inspection. Applicant requested a large family childcare license. The home is a single story home that consists of three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining room, garage and outdoor play area. The areas used for day-care are as followed; living room, kitchen, dining room, master bedroom, two (2) bathroom, and outdoor play area. The off limits areas consist of two (2) bedroom and garage. LPA observed a safety door knob covers on the bedroom and garage doors making the two (2) bedroom, and garage inaccessible to day-care children. LPA observed the kitchen to have safety locks on drawers and cabinets making these areas inaccessible to children in care. LPA observed that the FCCH is clean and orderly. In addition, there is plenty of ventilation for the children in care. LPA did not observe any toxins nor hazards items accessible to children in care. LPA observed that knives and medication are stored in an elevated cabinet in the kitchen. Cleaning compounds were observed in the garage secured with safety locks and inaccessible. The bathrooms to be used for children in care were observed to be clean and free of toxins. LPA observed children's tables, chairs, napping equipment and material for activities in the day-care room accessible to children in care. Continues on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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: DIAZ FCC	FACILITY NUMBER: 426216633
	VISIT DATE: 12/14/2023

NARRATIVE

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LPA and applicant toured the outdoor play area. The outdoor play area is completely fenced. LPA and applicant discussed active supervision when children are in the outdoor play area.

No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility

There are three (3) adults living in the home, all adults have been fingerprint cleared.

LPA observed a regulation 2A10BC fire extinguisher in the FCCH at the time of the inspection that was
purchased on November 28 , 2023. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed applicant test the smoke and carbon monoxide detectors in the home at 1:45 PM and were functioning at the time of the inspection.

Applicant stated that there are no weapons or ammunition in the home. Applicant stated she does hold a
foster family license. Applicant is current with immunization required per SB 792. The Applicant completed the Orientation on October 18, 2018. Applicant Pediatric First Aid/CPR certificate is valid until August 6, 2024. Applicant took the Preventative Health on September 14, 2019. Applicant’s Mandated Reporter Training certificate is valid until July 30,2025.

Control of property was verified via receipt of copy of mortgage statement. Because the applicant, rents/leases the home, proof of landlord notification is required. 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).

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

CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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: DIAZ FCC	FACILITY NUMBER: 426216633
	VISIT DATE: 12/14/2023

NARRATIVE

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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.

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, 12/13/2023, 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.

Continues on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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: DIAZ FCC	FACILITY NUMBER: 426216633
	VISIT DATE: 12/14/2023

NARRATIVE

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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. Community Care Licensing Division (CCLD) regularly sends information to licensed.

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: htttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child
Care option to receive email communication.

The Licensee is seeking the FCCH’s capacity of fourteen (Large FCCH) license. On 12/4/2023, the Department received a fire inspection clearance form from the City of Santa Maria fire Department for a capacity of fourteen. As such the FCCH's of capacity 14 is granted on the present, 12/14/2023.

The home meets Title 22 Division 12 requirements of a large FCCH license. Effective date of license will be noted as 12/14/2023. 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, Aide Diaz .

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

LIC809 (FAS) - (06/04)

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