426217018-7-3-2024-17-CC-SMAZ-D6TNYY-20240703105331

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426217018
Report Date: 07/03/2024
Date Signed: 07/03/2024 10:53:41 AM

Document Has Been Signed on 07/03/2024 10:53 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	RUBALCAVA FAMILY CHILD CARE		FACILITY NUMBER:	426217018
ADMINISTRATOR/ DIRECTOR:	MARIA RUBALCAVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 406-6718
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	07/03/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	MARIA RUBALCAVA		TIME VISIT/ INSPECTION COMPLETED:	11:08 AM

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 July 3, 2024 at 9:30 AM, Licensing Program Analysts (LPAs) Susana Martinez and Elizabeth George conducted an announced pre-licensing inspection for a large Family Child Care Home (FCCH). Previous license number is 426216483. Previous licensee's were Leonor Paz De Rubalcava and Maria Rubalcava. Leonor Paz De Rubalcava has moved out and is being removed from the current FCCH. LPAs met with applicant Maria Rubalcava and advised her of the purpose for the inspection. At the time of inspection there were no other adults in the home and no children present. Applicant denies having guns/ammunition in the home. Applicant plans on operating M-F 5:30 AM- 5:30 PM and Sat 5:30 AM- 1:30 PM. LPAs toured the interior and exterior of the home with the Applicant. This is a two- story home with four (4) bedrooms and two in a half (2.5) bathrooms, one (1) formal living room, one (1) regular living room, one (1) formal dining room, one (1) regular dining room, kitchen, laundry room, garage and outdoor yard. The home's living rooms, kitchen, dining areas, half (.5) bathroom and outdoor yard will be used for childcare services. Meanwhile, the laundry room, garage and entire second floor are off limits and inaccessible to children in care. LPAs observed both living rooms to have fire places that are secured. In addition, LPAs observed a baby gate located on the first step of the stairway, making the entire second floor inaccessible for children in care. LPAs observed a functioning dual smoke/carbon monoxide detector in the home which was tested at 9:53 AM. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed. The kitchen knives were observed to be located in a high cabinet which is out of reach of children. A regulatory 3-A-10-BC fire extinguisher is located in the kitchen with purchase date of 7/2/24. Applicant is reminded to service or purchase the fire extinguisher yearly. Applicant plans on providing meals to children in care. LPAs advised applicant to be cognizant of possible food allergies children may have. If food is not provided and food is brought from the children’s homes; containers shall be labeled with child’s name and properly stored or refrigerated. Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: RUBALCAVA FAMILY CHILD CARE	FACILITY NUMBER: 426217018
	VISIT DATE: 07/03/2024

NARRATIVE

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Children have access to toys that are age-appropriate inside and outside of the home. During the tour, LPA did not observe any hazards/toxins items accessible to children in care. An empty two tier water fountain was observed at the front of the home. Applicant states she plans to keep it empty, LPA's did not observe water in the fountain.

Applicant's Pediatric First Aid/CPR certificate is valid through 6/30/2024. Licensee was reminded to renew her certification every two years. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com. Applicant's mandated reporter certificate is valid through 7/06/2024.

The following was discussed with the applicant:

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization's, and a valid criminal record clearance associated to the facility license.
A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements was reviewed and explained.
Smoking is prohibited in a family child care home, 24/7.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs permitted in the facility.
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.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: RUBALCAVA FAMILY CHILD CARE	FACILITY NUMBER: 426217018
	VISIT DATE: 07/03/2024

NARRATIVE

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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.

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.

On this date, 07/03/2024, 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.

LPA discussed the safe sleep regulations with licensee 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.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: RUBALCAVA FAMILY CHILD CARE	FACILITY NUMBER: 426217018
	VISIT DATE: 07/03/2024

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.

LPA provided the following resources to applicant:

- Pictorial handout of items not permitted in a licensed facility

- Pictorial handout of capacity/ratio for Large FCCH

- Entrance Checklist was provided to the applicant.

- Disaster Drill Log

A fire clearance was granted by the Santa Maria Fire Department on 06/13/2024.

The home meets Title 22 Division 12 requirements of a Large FCCH. Effective date of license is today, July 03, 2024. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant Maria Christina Rubalcava.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC809 (FAS) - (06/04)

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