426216708-11-7-2023-17-CC-MJIZ-CXCS4Z-20231107123335

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216708
Report Date: 11/07/2023
Date Signed: 11/07/2023 12:33:43 PM

Document Has Been Signed on 11/07/2023 12:33 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:	CHAVEZ FAMILY CHILD CARE		FACILITY NUMBER:	426216708
ADMINISTRATOR:	YOLANDA CHAVEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 310-1795
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	11/07/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yolanda Chavez		TIME COMPLETED:	12:45 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 November 7, 2023 @ 9:00 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an announced Inspection for the purpose of performing a pre-licensing inspection. LPA Jimenez met with Yolanda Chavez, Applicant and Edgar Chavez, husband, the purpose of the Inspection was discussed. . LPA Jimenez and Applicant together toured the interior and exterior of the home. The home is 4 bedrooms, 3 bathrooms two story home. All adults in the home are fingerprint cleared. During this tour the following was noted: Applicant applied for a large Family Child Care license. Family members residing in the home are 2 adults. Per Applicant, the operating hours will be Monday through Friday from 6:30 a.m. to 5:00 p.m. Applicant states she wants to care for children from 0 to 13 years of age. All areas identified on the facility sketch were inspected. This is a two-story home which consists of four (4) bedrooms, three (3) restrooms, family room, kitchen, loft, day-care, dining room and completely fenced backyard. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Off limit areas included: four bedrooms, loft, two (2) bathrooms and garage. LPA observed child safety a gate at the bottom of the stairs , and door covers on the bedroom doors making the four bedrooms, loft, two (2) bathrooms and garage, inaccessible to children. LPA observed safety locks located in the kitchen. Areas used by children included: kitchen, dining room, family room, day-care room and hallway bathroom. Continues on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216708
	VISIT DATE: 11/07/2023

NARRATIVE

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The applicant states that she will provide food for children in care. There are age appropriate toys on the premises. Knives are stored out children’s reach, inaccessible to children.

The required fire extinguisher 2A10BC was purchased in August 28, 2023. Smoke detector and carbon monoxide detector were tested at 10:10 AM and were functioning at the time of the visit. . Per Applicant, there are guns and ammunition in a locked safe. LPA observed that the guns and ammunition were locked separately, at 9:39AM. First Aid and emergency kits are available.

The Applicant completed the Orientation on April 21, 2023. The Applicant has current Pediatric First Aid and CPR which expires, April 21, 2025. Applicant took the Preventative Health on June 13, 2023. Applicant completed the Mandated Reporter Training on June 1, 2023. Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles. The applicant, provided proof of control of property. 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).

The following was discussed with the applicant:
· Individuals who are 18 years of age or older living in the home or working in the home, must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain the Criminal Record Background Check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization's, and a valid criminal record clearance associated to the facility license.
· A current roster of children enrolled must be available for review and maintained for a period of three years, even after children are no longer attending the facility.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
· Changes in the home should be reported to the Department as soon as they occur such as construction,
remodeling, telephone number changes and/or if applicant moved to another location/ home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within
CONTINUES ON LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216708
	VISIT DATE: 11/07/2023

NARRATIVE

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24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements were reviewed and explained.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a Family Child Care Home, 24/7.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· All adults living and working in the home shall be made of aware of the Department inspection rights authority.

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.

Applicant was reminded that all adults 18 and over living or working in the home, 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-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 Continues on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216708
	VISIT DATE: 11/07/2023

NARRATIVE

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recalls on their purchased equipment.

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.

On this date, October 17, 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.

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.

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.

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. Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

The home meets Title 22 Division 12 requirements of a large FCCH license. Effective date of license will be noted as November 7, 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, Yolanda Chavez.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC809 (FAS) - (06/04)

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