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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217150
Report Date: 10/21/2024
Date Signed: 10/21/2024 01:23:23 PM

Document Has Been Signed on 10/21/2024 01:23 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:VASQUEZ FAMILY CHILD CAREFACILITY NUMBER:
426217150
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/21/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:01 AM
MET WITH:Mayra VasquezTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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On 10/21/2024 Licensing Program Analysts (LPAs) German Negrete and Matthew Sapien conducted an announced Pre-licensing inspection and met with applicant Mayra Vasquez. LPAs informed Applicant the nature and purpose of the inspection. LPAs and applicant toured the inside and outside of the home. There were no children in care at the time of the inspection. The two adults living in the home have a current fingerprint clearance.

Applicant requested a small family childcare license. The home is a single-story home which consists of Master-bedroom/bathroom, Bedroom#1, Bedroom#2, Hallway-Bathroom, living room, kitchen, garage and outdoor play area that is fenced off. The areas used for day-care are as followed: living room #1 &,dining room, hallway bathroom and outdoor play area. The off-limits areas consist of bedroom#1 & #2, Master-bedroom/bathroom, garage. LPAs observed child proof locks on master-bedroom/bathroom doors, bedroom#1 & #2 doors and garage doors making the areas inaccessible to day-care children. The bathroom to be used for children in care was observed to be clean and free of toxins. LPAs observed home has age-appropriate chairs, tables, equipment, toys and other materials for childcare activities.

Continued on LIC809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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 5
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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217150
VISIT DATE: 10/21/2024
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LPAs observed the home is clean and orderly. In addition, there is plenty of ventilation for the children in care. LPAs did not observe any toxins accessible to children in care. The knives in the kitchen are elevated(5 feet) inside a cabinet making these items inaccessible to children in care. No hazardous items were observed to be accessible to children in the home. Medication is stored in a locked cabinet in the kitchen. Cleaning compounds were observed in the garage making these items inaccessible to children in care. There are no bodies of water on the property. Applicant stated no guns or ammunition are in the home.

LPA observed a fire extinguisher (2-A-10-B-C) in the home. The fire extinguisher was serviced on 06/01/2024 . LPAs reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a smoke detector and a separate carbon monoxide detector, both were tested and observed operable on 10/21/2024 at 11:10am.

LPAs record review revealed Applicant is current with immunization's required by SB792. Mandated Reporter training was completed and valid until 07/25/2026. Pediatric CPR/First Aid (EMSA approved) training was completed 07/13/2024 and expires 07/13/2026. Applicant completed Preventative Health Training on 04/20/2024, and the CCLD Orientation on 06/11/2024. LPAs reminded Applicant of obligation to maintain current training and certifications. The applicant owns the home and provided proof of control of property(mortgage statement).

Continued on LIC809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217150
VISIT DATE: 10/21/2024
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Applicant was informed baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours.

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.

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 and provided copies to applicant of forms listed in 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 on LIC809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217150
VISIT DATE: 10/21/2024
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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-andresources/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, 10/19/2024, 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.

Continued On LIC809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217150
VISIT DATE: 10/21/2024
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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.

LPAs observed trampoline at the Applicant's home. Applicant stated that she will be removing the trampoline from the backyard. Applicant will take a photo of the backyard after the trampoline is removed and submit the photo to the department. License will be pending manager's review.

Exit interview conducted and inspection report was reviewed with the applicant.

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

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5