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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216977
Report Date: 06/13/2024
Date Signed: 06/13/2024 11:22:07 AM

Document Has Been Signed on 06/13/2024 11:22 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:VILLAGOMEZ FAMILY CHILD CAREFACILITY NUMBER:
426216977
ADMINISTRATOR/
DIRECTOR:
MANUEL VILLAGOMEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 420-6567
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/13/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Manuel Villagomez TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On June 13, 2024, Licensing Program Analyst (LPA) Giovani Gonzalez conducted an announced Prelicensing inspection at the above-mentioned residence. LPA met with applicant Manuel Villagomez and informed them the purpose of the inspection. At the time of the inspection no children were present. Applicant informed LPA the intention to provide care for children ages 0-14 years old and have operating hours of 5AM -12AM, Monday through Sunday.

LPA in the company of the applicant toured the interior and exterior of the residence in its entirety. The residence is a single story home that consists of 3 bedrooms, 1.5 bathrooms, 2 living rooms, kitchen, dining area, attached garage and backyard. The home will be using the back living room, half bathroom and backyard for child care purposes while the remainder of the home is excluded from care. LPA notes that the main part of the home is inaccessible to children via a combination of a child proof gate and child proof locks.
LPA observed the home to be clean and orderly. The home has sufficient spacing and ventilation for children in care. LPA observed the living room to have plenty of equipment and furniture for children. LPA observed a fire place and an indoor barbecue grill in the living room, both of which have been covered and are inaccessible to children. LPA observed the bathroom for children to be clean and free of toxins. LPA observed that the kitchen is inaccessible to children in care via child proof gate. LPA observed sharps and cleaning compounds to be stored in the kitchen pantry on an elevated surface. LPA observed the doors leading to the main part of the home to have child proof locks. LPA reminded applicant that in order for the remainder of the home to be inaccessible to children the doors must remain locked.

LPA observed the backyard to be completely enclosed. LPA observed plenty of space for children's activities. LPA observed that the entry/exit ways are secured with latches and have the ability to be locked. LPA observed that the home has 2 dogs. Applicant stated that the dogs are up to date on their vaccinations. LPA did not observe any bodies of water on site.
CONTINUED PAGE 2
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: VILLAGOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216977
VISIT DATE: 06/13/2024
NARRATIVE
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LPA observed a fire extinguisher that satisfies regulation (3A40BC) which was serviced on 3/19/2024. LPA reminded applicant that it is their responsibility to purchase or service a regulation fire extinguisher annually. The home has a smoke detector and a carbon monoxide detector which were tested at 9:56AM. Applicant stated there are no fire arms in the home.

LPA's record review revealed applicant's Preventative Health Training was completed on 2/3/2024. Further, applicant completed Mandated Reporter training on 10/4/2023 and Pediatric CPR/First Aid (EMSA approved) on 9/10/2023. Applicant completed FCCH orientation on 3/20/2024. LPA reminded applicant of obligation to maintain current training and certifications.

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.

The applicant provided proof of control of property. Applicant provided a mortgage statement.

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

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: VILLAGOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216977
VISIT DATE: 06/13/2024
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On this date, 6/13/2024, 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 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.

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.

The home meets Title 22 of CCR requirements for a Small Family Child Care license. The effective date of license is noted as the present 6/13/2024.

Exit interview conducted and report was reviewed with the applicant Manuel Villagomez. Notice of site visit was given.



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

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
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