426216993-6-14-2024-17-CC-GGOZ-D68QZR-20240614123709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216993
Report Date: 06/14/2024
Date Signed: 06/14/2024 12:38:34 PM

Document Has Been Signed on 06/14/2024 12:38 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	ROSALES FAMILY CHILD CARE		FACILITY NUMBER:	426216993
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	06/14/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:01 AM
MET WITH:	Dolores Rosales		TIME VISIT/ INSPECTION COMPLETED:	12:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On June 14, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an announced Prelicensing inspection at the above-mentioned residence. LPA met with applicant Dolores Rosales and informed them the purpose of the inspection. Applicant informed LPA the intention to maintain operating hours of 6AM-5PM, Monday through Friday and 7AM-1PM Saturday. Applicant has the intention to provide care for children ages 1-12 years old. At the time of the inspection the applicant's 1 child was present. 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, 2 bathrooms, living room, dining area, kitchen, attached garage, and backyard. The home will be using 1 bedroom, 1 bathroom, living room, dining area and backyard for child care purposes while the remainder of the home will be excluded from care. 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 of equipment and furniture for children. LPA observed the living room to have an electric fire place that is made inaccessible with a child gate. LPA observed the bedroom to be used for child care purposes to be clean and free of hazards. LPA observed the remainder of the bedrooms to be made inaccessible to children via a child proof gate in the hallway leading to the rooms. LPA reminded applicant that in order for areas to remain inaccessible they must be secured. LPA observed all the bottom cabinets and drawers in the kitchen to be secured with child proof locks. LPA observed sharps and medication to be stored on an elevated surface in the kitchen as well. LPA observed the door leading to the attached garage to be secured with a child proof lock. Applicant informed LPA that they keep their cleaning compounds in the garage. LPA observed the bathroom to be used for child care purposes to be clean and free of toxins. LPA observed the backyard to be completely enclosed. LPA observed plenty of space for children's activities. CONTINUED PAGE 2

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

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: ROSALES FAMILY CHILD CARE	FACILITY NUMBER: 426216993
	VISIT DATE: 06/14/2024

NARRATIVE

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LPA observed that the entry/exit ways are secured with latches and have the ability to be locked. LPA observed a canopy that will be used to provide shade for the children. LPA did not observe any bodies of water on site.

LPA observed a fire extinguisher that satisfies regulation (3A40BC) which was serviced on 6/9/2024. 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 10:09AM and found in working order. Applicant stated there are no fire arms in the home.

LPA's record review revealed applicant's Preventative Health Training was completed on 2/11/2024. Further, applicant completed Mandated Reporter training on 2/14/2024 and Pediatric CPR/First Aid (EMSA approved) on 3/9/2024. Applicant completed FCCH orientation on 2/20/2024. 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. 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 6 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 8 children.

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.
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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

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: ROSALES FAMILY CHILD CARE	FACILITY NUMBER: 426216993
	VISIT DATE: 06/14/2024

NARRATIVE

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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. 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, 6/14/2024, 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 6/14/2024.

Exit interview conducted and report was reviewed with the applicant Dolores Rosales. 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: 06/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

LIC809 (FAS) - (06/04)

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