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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216903
Report Date: 05/22/2024
Date Signed: 05/23/2024 02:03:21 PM

Document Has Been Signed on 05/23/2024 02:03 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:BARAJAS FAMILY CHILD CAREFACILITY NUMBER:
426216903
ADMINISTRATOR/
DIRECTOR:		JESSICA BARAJASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 840-8810
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
05/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Jessica BarajasTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 5/22/2024, at 12:15 PM Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Pre-licensing Inspection of the above-mentioned home and met with Applicant/Licensee, Jessica Barajas. LPA informed Applicant/licensee of the nature and purpose of the inspection. This inspection is being conducted to remove the co-Licensee, Mario Barajas, Licensee’s partner, from the Family Child Care Home Licenses. As a result, a new license number will be issued, which requires this inspection being classified as a pre-licensing inspection. FCCH hours of operation is from Monday to Friday, 5:00 AM to 6:00 PM serving children from 6 months old to 13 years of age.


LPA, in the company of Applicant/Licensee, toured the interior and exterior of the home. LPA observed 5 children in care. The residential home is a single-story dwelling with 4 bedrooms and two bathrooms. The home’s family room converted into the play area, one bedroom, dining room, fenced back yard, one bathroom will be accessible to day care children. The home's living room, kitchen, 2 bedrooms and garage will be excluded from children’s use. Living room, hallway will only be accessed as pathway leading to the day care room.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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 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: BARAJAS FAMILY CHILD CARE
FACILITY NUMBER: 426216903
VISIT DATE: 05/22/2024
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The bathroom used by children in care is observed to be clean and free of toxins. LPA observed cleaning solutions and sharps are secured in the kitchen cabinet, while medication is kept in the maser’s bedroom. The aforementioned items will be inaccessible to children. The home has working telephone services.

LPA observed a fire extinguisher (2A10BC) in the home which was purchased on 3/13/2024. 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 hallway was tested at 1:08 pm and found to be operable.

The backyard is enclosed with a wall-to-wall wooden fencing No bodies of water were observed on site. Applicant/Licensee stated that there is a gun at home that is locked in the inaccessible area and no ammunition is in the home.



LPA's record review revealed Applicant's Mandated Reporter training was completed on 1/18/2024 (expires on 1/18/2026) and Pediatric CPR/First Aid (EMSA approved) training was completed on 5/21/2023 (expiration (5/21/2025). Applicant completed Preventative Health Training on 11/17/2022, and the CCLD Orientation on 10/25/2022. LPA reminded Applicant of obligation to maintain current training and certifications.

Continued on LIC 809C

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

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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: BARAJAS FAMILY CHILD CARE
FACILITY NUMBER: 426216903
VISIT DATE: 05/22/2024
NARRATIVE
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Because the Applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant 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.

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.



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

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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: BARAJAS FAMILY CHILD CARE
FACILITY NUMBER: 426216903
VISIT DATE: 05/22/2024
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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.

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.



Notice of Site Visit was issued. Appeal Rights was given.

Exit interview conducted and report was reviewed with the Applicant Jessica Barajas.

The home meets Title 22 Division 12 requirements of a Large (12) FCCH License. The license is effective today, 5/22/2024.

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

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC809 (FAS) - (06/04)
Page: 4 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: BARAJAS FAMILY CHILD CARE
FACILITY NUMBER: 426216903
VISIT DATE: 05/22/2024
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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. 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.

Licensee/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, 5/22/2024, 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.

Continued on LIC 809 C

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

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5