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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216890
Report Date: 04/02/2024
Date Signed: 04/02/2024 04:41:04 PM

Document Has Been Signed on 04/02/2024 04:41 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:FUENTES FAMILY CHILD CAREFACILITY NUMBER:
426216890
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/02/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Marissa FuentesTIME COMPLETED:
04:45 PM
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On 4/2/24 at 2:50 PM, Licensing Program Analysts (LPAs) Francisca Velazquez and Joaquin Mendez conducted an announced Pre-licensing Inspection and met with Applicant, Marissa Fuentes. LPAs informed Applicant of the nature and purpose of the inspection. The applicant informed LPAs of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 12:00 AM to 11:59 PM, Monday- Saturday. The applicant also informed LPAs of the intention to provide care for children from 0 months to 12 years of age. Applicant was informed changes in licensing hours and/or the ages of children supervised and cared for can be altered upon notifying CCLD in writing of the given modifications and/or changes. The applicant reports there is one (1) adult that live in the home and one (1) adult has received criminal record clearance.

LPAs toured the interior and exterior of the residence with the Applicant. This is a single-story studio that consists of two (2) bedrooms, one (1) bathroom, living room, kitchen, laundry room and outdoor yard. Applicant reported day care services will occur in one (1) bedroom, the living room, kitchen, (1) bathroom and outdoor yard. Meanwhile one (1) bedroom and the laundry room will be inaccessible to children in care. LPAs observed the inaccessible bedroom has a door safety knob and the laundry room is locked and requires a key to open.

LPAs observed that the living room, kitchen, one (1) bedroom, one (1) bathroom and the outdoor yard to have plenty of spacing and ventilation for the comfort of children in care. LPAs observed an open face heater in the living room that needs to be made inaccessible to children in care. LPAs observed sharps are stored in a kitchen drawer that is locked. Cleaning compounds are stored under the kitchen sink that is locked, in the laundry room that is locked and in the outdoor shed that is locked as well. Medication for the family is stored in an elevated cabinet in the kitchen. LPAs observed all these areas are inaccessible to children in care. The bathroom that will be used by children was observed to be clean and free of toxins. LPAs observed items, equipment, toys, and furnishings for the children in care that are in good condition and age appropriate.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024
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 4
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: FUENTES FAMILY CHILD CARE
FACILITY NUMBER: 426216890
VISIT DATE: 04/02/2024
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LPAs observe a required fire extinguisher (2A10BC) in the home that was purchased on 4/2/24. LPAs 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 3:10 PM and was operable.
LPAs toured the outdoor yard and observed the outdoor yard to be completely fenced and the exit doors secured. LPAs observed there is some shading for the children, but LPAs and Applicant discussed adding additional shading during the summer months. LPAs observed one (1) shed that is locked and inaccessible to children in care. Applicant reported filtered water will be accessible by means of a filtration system built in the refrigerator with individual and disposable water cups. LPAs note no bodies of water were observed. Applicant reported there are no guns and ammo in the home.

LPA's record review revealed Preventative Health training was complete on 10/20/22. Further, Applicant completed Mandated Reporter training on 2/9/23 and Pediatric CPR/First Aid (EMSA approved) on 1/17/23. Applicant completed FCCH orientation on 10/1/22. LPA reminded Applicant of obligation to maintain current training and certifications. Applicant does not have liability insurance for the license as of yet. LPAs 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.

Applicant rents/leases the home and has landlord consent. Because the applicant, rents/leases the home, proof of landlord notification is required. The LPAs 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.

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

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
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: FUENTES FAMILY CHILD CARE
FACILITY NUMBER: 426216890
VISIT DATE: 04/02/2024
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LPAs 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, 4/2/24, 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.

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, Marissa Fuentes in Spanish.

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

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: FUENTES FAMILY CHILD CARE
FACILITY NUMBER: 426216890
VISIT DATE: 04/02/2024
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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 does not meet Title 22 of CCR requirements for a Small Family Child Care license. The following corrections are pending prior to issuing Small Family Child Care license.

1. Open face heater in the living room must be made inaccessible to children in care.
2. Proof that the studio is its own independent address (City Permit).
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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