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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216989
Report Date: 06/20/2024
Date Signed: 06/20/2024 03:25:45 PM

Document Has Been Signed on 06/20/2024 03:25 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:SILVA FAMILY CHILD CAREFACILITY NUMBER:
426216989
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Leticia Silva and Lizeth MartinezTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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On 6/20/2024 at 12:25 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced Pre-licensing Inspection of the above-mentioned home and met with Applicant, Leticia Silva, adult child, Lizeth Martinez and adult Godchild, Jaqueline Oropeza. LPA informed Applicant of the nature and purpose of the inspection. Applicant plans to operate the Family Child Care Home (FCCH) from Sunday to Saturday from 5 AM to 7:00 PM with night care available on Sundays and Mondays. If this operating schedules materialized the applicant will hire an assistant to support the extended hours. Applicant also plans to care for children 0 years of age to 13 years of age.

LPA, in the company of Applicant and daughter toured the interior and exterior of the home. LPA did not observe any children present. The residential home is a single-story dwelling with 4 bedrooms and two bathrooms. The living room, dining, one bathroom and fenced backyard will be accessible to children. Four (4) bedrooms, garage and the left side yard will be excluded from children’s use.



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 laundry room cabinet, sharps are observed in the elevated cabinet, while medication and first aid kit in the home is also secured in the cabinet by the diaper changing station.
Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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: SILVA FAMILY CHILD CARE
FACILITY NUMBER: 426216989
VISIT DATE: 06/20/2024
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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 serviced on 5/5/2024 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 and found to be operable.

The backyard area of the home is enclosed by wall-to-wall wooden fencing, and the surface is partially concrete and partially grass. Applicant will place partition gate to separate the left side yard from children’s play yard. No bodies of water were observed on site.



LPA's record review revealed Applicant's Mandated Reporter training was completed on 2/6/2024 (expires on 2/6/2026) and Pediatric CPR/First Aid (EMSA approved) training was completed on 03/24/2024 (expiration (3/24/2026). Applicant completed Preventative Health Training on 3/22/2024, and the CCLD Orientation on 1/24/2024. LPA reminded Applicant of responsibility to maintain current training and certifications.

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 obtained a signed Property Owner/Landlord Consent form (LIC 9149). Licensee informed LPA no ammunition or firearms are on site.

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

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
Page: 2 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: SILVA FAMILY CHILD CARE
FACILITY NUMBER: 426216989
VISIT DATE: 06/20/2024
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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. Prohibited items and equipment in the FCCH, such as walkers, bouncers, etc., were also reviewed with the applicant,

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. 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.


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

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
Page: 3 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: SILVA FAMILY CHILD CARE
FACILITY NUMBER: 426216989
VISIT DATE: 06/20/2024
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LPA discussed the requirement for care providers/employees, including volunteers, to obtain immunization against Influenza, Pertussis, Measles, including verification of TB, with applicant's verification being on file.

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, 6/20/2024, 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.

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.

Continued on LIC 809C

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

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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: SILVA FAMILY CHILD CARE
FACILITY NUMBER: 426216989
VISIT DATE: 06/20/2024
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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.

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.



Exit interview conducted and report was reviewed with the Applicant, Leticia Silva. Report and inspection were translated in Spanish by Applicant’s Godchild, Jaqueline Oropeza

Notice of Site Visit was issued and must be posted for 30 days.

Issuance of small Family Child Care Home License is pending until the following requirements are completed within ten days.

- Barricade the left side yard to make it inaccessible to children.

- Removal of the wood fencing leaning against the fence in the side yard.

- Replace the plate of electrical outlet by the dining area.

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

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5