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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216895
Report Date: 05/24/2024
Date Signed: 05/24/2024 01:10:25 PM

Document Has Been Signed on 05/24/2024 01:10 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
426216895
ADMINISTRATOR/
DIRECTOR:		RODRIGUEZ, CINDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 350-8669
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
05/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Cindy RodriguezTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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On 5/24/2024 at 11:05 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced Pre-licensing Inspection of the abovementioned home. LPA met with Applicant, Cindy Rodriguez and spouse, Miguel Angel Perez. LPA informed Applicant of the nature and purpose of the inspection. Applicant plans to operate of the Family Child Care Home (FCCH) Monday to Friday, from 7:00 AM to 5:30 PM. Applicant also intends to care for children 0 years of age to 12 years of age.

Applicant has applied for a license to operate a large FCCH. Applicant has more than one year of experience in the field of early childhood education as a teacher in a licensed Child Care Center. Credential was submitted to the department.



LPA, in the company of Applicant, toured the interior and exterior of the home. LPA observed three biological children of the applicant. The residential home is a single-story dwelling with three bedrooms and two bathrooms. The home’s family room converted into a play area, fenced backyard and one bathroom will be accessible to day care children. The home's living room, kitchen, dining area, bedrooms and garage will be excluded from children’s use.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216895
VISIT DATE: 05/24/2024
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 Living room, hallway and dining will only be accessed as pathway leading to the day care room and to use the bathroom. Day care area is enclosed with a baby gate, separating from the living room and dining area. The completely fenced back yard is also divided with a wooden gate to separate the children’s yard (left side of the home) from the home’s personal yard (right side of the home).

LPA observed the home to be clean and orderly. The bathroom to be used by children in care is observed to be clean and free of toxins. LPA observed cleaning solutions are stored in the garage and sharps are observed in a secured elevated cabinet, while medication in the home is kept in the bedroom. The aforementioned items will be inaccessible to children. The home has working telephone services. LPA observed aged appropriate toys, equipment, and books. Cots and crib are also present. Applicant was reminded that 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.

LPA observed a fire extinguisher (2A10BC) in the home which was purchased on 4/16/2024. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. Combination smoke/carbon monoxide detector located in the home's living room was tested at 12:15 PM and found to be operable. Applicant stated that there are no guns or ammunition in the home. No bodies of water was observed.


Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216895
VISIT DATE: 05/24/2024
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LPA's record review revealed Applicant's Mandated Reporter training was completed on 12/11/2023 (expires on 12/11/2025) and Pediatric CPR/First Aid (EMSA approved) training was completed on 9/19/2023 (expiration (9/19/2025). Applicant completed Preventative Health Training on 11/15/2023 and the CCLD Orientation on 11/29/2022. LPA reminded Applicant of obligation to maintain current training and certifications. Control of Property was reviewed and verified.

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.

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 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.

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216895
VISIT DATE: 05/24/2024
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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.

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 informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.



Fire Safety clearance was granted on 4/29/2024. The home meets the Title 22 Division 12 requirements of a Large Family Child Care Home. License is effective today, 5/24/2024.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216895
VISIT DATE: 05/24/2024
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 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 of infant devices or their purchased equipment.

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.



On this date, 5/24/2024, 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 address. 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.

Continued on LIC 809 C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5