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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217125
Report Date: 10/03/2024
Date Signed: 10/03/2024 11:35:13 AM

Document Has Been Signed on 10/03/2024 11:35 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:AYALA FAMILY CHILD CAREFACILITY NUMBER:
426217125
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/03/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:33 AM
MET WITH:Susana Ayala TIME VISIT/
INSPECTION COMPLETED:
11:48 AM
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On October 3, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an announced Prelicensing inspection at the abovementioned residence. LPA met with applicant Susana Ayala Mota and informed them the purpose of the inspection. Applicant informed LPA the intention to care for children ages 0-12 years old. Applicant also informed LPA the intention to have operating hours of 5AM-6PM Monday-Friday and 5AM-4PM Saturday. At the time of the inspection no children were 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 consisting of 3 bedrooms, 2 bathrooms, living room, kitchen, ADU and backyard. The home's living room, 1 bathroom and backyard will be used for child care purposes while the remainder of the home will be excluded from care.

LPA observed the interior of the home to be clean and have sufficient ventilation for children in care. LPA observed the living room to be free of hazards. LPA observed a fireplace that is covered with a fence that secured to the wall. LPA observed all lower kitchen cabinets to be secured with child proof locks. LPA observed sharps to be stored in an elevated cabinet beyond the reach of children. LPA observed cleaning products and medication to be stored in an elevated hallway cabinet. LPA observed the bedrooms to be secured with child proof locks. LPA observed the door leading to the ADU to be secured with a child proof lock. LPA reminded applicant in order for areas to be inaccessible the doors must always be secured. LPA observed the bathroom to be used for children in care to be clean. LPA observed all the bathroom cabinets/drawers to be secured with child proof locks. LPA reminded applicant to ensure hygiene products are not accessible when children are in care.

LPA observed the backyard to be completely enclosed. LPA observed some areas of the yard to be off limits. LPA observed an off limit area with various hazards and to have a latch within reach of children.
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SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 426217125
VISIT DATE: 10/03/2024
NARRATIVE
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 LPA informed applicant prior to licensure they must secure the area. LPA observed a storage shed containing power tools and paint that was not able to be completely secured. LPA informed applicant, prior to licensure they must secure the storage shed. LPA observed a metal pole stocking out form the dirt in the children's area and informed applicant it must be removed prior to licensure. LPA observed the yard to have sufficient space for children's activities. LPA observed the exit/entry way of the backyard to be secured with a latch that is beyond the reach of children.

LPA observed a fire extinguisher that satisfies regulation (2A10BC) which was purchased on 6/14/2024. LPA reminded applicant that it is their responsibility to purchase or service a regulation fire extinguisher annually. LPA observed the home has a smoke detector(tested at 10:08AM) and a carbon monoxide detector (tested 9:44AM) which were found in working order. Applicant stated that there are no fire arms in the home.

LPA's record review revealed applicant's Preventative Health Training was completed on 6/28/2024. Further, applicant completed Mandated Reporter training on 6/20/2024 and Pediatric CPR/First Aid (EMSA approved) on 6/25/2024. Applicant completed FCCH orientation on 6/17/2024. LPA reminded applicant of obligation to maintain current training and certification.

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. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 426217125
VISIT DATE: 10/03/2024
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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. 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, 10/3/2024, 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.


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

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 426217125
VISIT DATE: 10/03/2024
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Prior to licensure the following corrections must be made:

- Fence for the off limits area must be secured
- Storage shed must be secured
- Pole in the ground must be removed.

Exit interview conducted and report was reviewed with the applicant Susana Ayala Mota.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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