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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217092
Report Date: 07/25/2024
Date Signed: 07/25/2024 03:27:53 PM

Document Has Been Signed on 07/25/2024 03:27 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:AREVALO FAMILY CHILD CAREFACILITY NUMBER:
426217092
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/25/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:13 AM
MET WITH:Meleena Arevalo TIME VISIT/
INSPECTION COMPLETED:
03:42 PM
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This is a change of location, previous facility number 426216728.

On July 25, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an announced Prelicensing - Change of Location inspection at the above-mentioned residence. LPA met with applicant Meleena Arevalo and informed them the purpose of the inspection. LPA in the company of the applicant toured the interior and exterior of the home in its entirety. At the time of the inspection there were no children present



Applicant requested a change of location for Small Family Child Care Home on 7/15//24. The residence is a single story house, consisting of 3 bedrooms, 2 bathrooms, living room, kitchen, dining area, attached garage and backyard. The home's living room, dining area, 1 bathroom, and backyard will be used for child care purposes while the remainder of the home is excluded from care.

LPA observed the interior of the home to have sufficient space and ventilation for children in care. LPA observed children's area to be clean and orderly. LPA observed bedrooms to be made inaccessible to children with locks. LPA informed applicant that in order for bedrooms to be inaccessible they must be locked during day care hours. LPA observed the kitchen to be accessible to children. LPA observed all lower kitchen cabinets and drawers to be secured with child proof locks. LPA observed sharps and medications to be stored in elevated cabinets beyond the reach of children. LPA observed the door leading to the garage to be made inaccessible to with a lock. LPA informed applicant that the garage door must be locked in order for it to be inaccessible to children. LPA observed the bathroom to be used for child care purposes to be clean and free of hazards.

LPA observed the backyard to be completely enclosed. LPA observed the exit way to be secured with latches that are inaccessible to children. LPA observed the backyard to have sufficient space for children's activities. LPA observed a storage shed in the backyard to be secured with the lock and is inaccessible to children. CONTINUED PAGE 2

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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: AREVALO FAMILY CHILD CARE
FACILITY NUMBER: 426217092
VISIT DATE: 07/25/2024
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LPA observed a fire extinguisher that satisfies regulation (3A40BC) that was purchased 11/6/2023. LPA reminded applicant to purchase or service a regulation fire extinguisher annually. LPA observed a combination smoke and carbon monoxide detector which was tested at 1:35PM and found to be operational. Applicant informed LPA that there are no firearms in the home. Applicant's Mandated Reporter training was completed on 3/5/2023, and CPR/First aid was completed on 4/2/2023. LPA informed applicant that it is their responsibility to ensure that their training and certificates are current.

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.

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

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
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: AREVALO FAMILY CHILD CARE
FACILITY NUMBER: 426217092
VISIT DATE: 07/25/2024
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On this date, 7/25/2024, 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 7/25/2024.

Exit interview was conducted with Meleena Arevalo and notice of site visit was given.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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