<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217063
Report Date: 07/23/2024
Date Signed: 07/23/2024 03:47:05 PM

Document Has Been Signed on 07/23/2024 03:47 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:CHAVEZ FAMILY CHILD CAREFACILITY NUMBER:
426217063
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
07/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Victoria Chavez TIME VISIT/
INSPECTION COMPLETED:
03:55 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 July 23, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an announced inspection at the above-mentioned residence. LPA met with applicant Victoria Chavez and informed the purpose of the inspection. The applicant informed LPA the intention to provide care for children ages 0-12 years old and to have operating hours of Monday - Saturday 4AM - 6PM. At the time of the inspection 2 of the applicant's grandchildren were present.

LPA in the company of the applicant toured the interior and exterior of the residence in its entirety. The residence is a 2 story condo consisting of 3 bedrooms, 3 bathrooms, living room, kitchen, attached garage and out door patio. The home will be using the downstairs bathroom, living room, kitchen and part of the outdoor patio for childcare purposes while the remainder of the home is excluded from care. LPA notes that all 3 upstairs bedrooms are made inaccessible with a child gate at the bottom of the stairs.

LPA observed the interior of the home to have sufficient space and ventilation for children in care. LPA observed the living room and kitchen to be clean and orderly. LPA observed the kitchen to be accessible to children and that all lower cabinets are secured with child proof locks. LPA observed knives to be stored in an elevated cabinet that is also secured with a child proof lock. Applicant informed LPA that all medication is stored upstairs which is inaccessible to children. LPA observed the sliding door leading to the dog's area of the patio to be secured with a child proof lock as well. Applicant stated that their dog is up to date with their vaccinations. LPA observed the cleaning compounds to be stored in the attached garage. LPA observed the garage door to be secured with a child proof lock as well. LPA observed the bathroom to be used for children to be clean and free of hazards.

LPA observed the patio area to be used for child care purposes to be completely enclosed. LPA observed part of the patio to be used for their dog and that entrance/exit way to the dog's area to be secured with
CONTINUED PAGE 2
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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 3
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: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217063
VISIT DATE: 07/23/2024
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
26
27
28
29
30
31
32
a child proof lock. LPA observed the entrance/exit way of the patio to be secured as well with a latch that is beyond the reach of children in care.

LPA observed a fire extinguisher that satisfies regulation (2A10BC) which was purchased on 7/16/2024. 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 1:32PM and found in working order. Applicant stated that there are fire arms in the home. LPA notes that fire arm storage complies with regulation.

LPA's record review revealed applicant's Preventative Health Training was completed on 4/20/2024. Further, applicant completed Mandated Reporter training on 11/20/2023 and Pediatric CPR/First Aid (EMSA approved) on 3/9/2024. Applicant completed FCCH orientation on 9/15/2021. 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.

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.
CONTINUED PAGE 3
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217063
VISIT DATE: 07/23/2024
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
26
27
28
29
30
31
32
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, 7/23/2024, 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.

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

The home meets Title 22 of CCR requirements for a Small Family Child Care License. Effective date of the license will be noted as the present 7/23/2024.

Exit interview was conducted with applicant Victoria Chavez. Notice of site visit was given.

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

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3