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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216804
Report Date: 02/23/2024
Date Signed: 02/23/2024 10:27:32 AM

Document Has Been Signed on 02/23/2024 10:27 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:RODRIGUEZ FCC AKA CLOUD HAVEN CHILDCAREFACILITY NUMBER:
426216804
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 7CENSUS: 2DATE:
02/23/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Vianna RodriguezTIME COMPLETED:
10:45 AM
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On February 23 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management – Change of Capacity inspection at the abovementioned Family Child Care Home (FCCH).This inspection will also serve to approve the use of the backyard as well. LPA met with Licensee Vianna Rodriguez and informed them the purpose of the inspection. At the time of the inspection there were 2 children present.

LPA in the company of the Licensee toured the FCCH. LPA observed the FCCH’s interior and exterior to be free of hazardous materials that could pose a danger to children in care.

LPA observed the upper level of the backyard to be enclosed by a fence. Licensee informed LPA that they will only be using the upper level of the backyard for child care purposes. LPA observed the exit gate to be secured. LPA observed a storage shed and reminded Licensee that it must remain inaccessible to children in care. LPA also observed a swing and reminded Licensee that they must insure that it is age appropriate for children. LPA observed a fire pit that is fenced off with a child gate. LPA reminded Licensee that if they choose to use the lower level of the backyard it must be inspected prior to being used for child care purposes.

LPA observed a regulation fire extinguisher (2A10BC) which was purchased 11/22/2023. LPA reminded Licensee the responsibility to service or purchase a regulation fire extinguisher annually. LPA observed a combination smoke and carbon monoxide detector which was tested and found to be operational at 9:51AM. LPA reviewed Licensee’s Mandated Reporter Training certificate which was completed 11/24/23 . LPA reviewed Licensee’s Pediatric CPR/First Aid which was completed 11/19/2022.

The Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 6 (Small FCCH) to 12 (Large FCCH). The Santa Barbara County Fire Department granted a fire clearance following an inspection completed at FCCH on 2/9/2024.

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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: RODRIGUEZ FCC AKA CLOUD HAVEN CHILDCARE
FACILITY NUMBER: 426216804
VISIT DATE: 02/23/2024
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The Licensee has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 12 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 14 children.

The home meets Title 22 of CCR requirements for a Large Family Child Care license. The home's upper level of the backyard is approved for child care purposes. The effective date of license is today 2/23/2024.

Exit interview was conducted and Notice of Site visit was given.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC809 (FAS) - (06/04)
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