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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217156
Report Date: 10/24/2024
Date Signed: 10/24/2024 12:10:26 PM

Document Has Been Signed on 10/24/2024 12:10 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:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
426217156
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Lisette JimenezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 10/24/2024, at 9:15 AM, Licensing Program Analyst (LPA) Joaquin Mendez conducted an announced Pre-licensing Inspection and met with Applicant, Lisette Jimenez. LPA informed Applicant of the nature and purpose of the inspection. The applicant informed the LPA of the intention to maintain operating hours of a Family Childcare Home (FCCH) from 7:30 AM to 5:30 PM, Monday- Friday. The applicant also informed LPA of the intention to provide care for children newborn to 4 years of age. Applicant was informed changes in licensing hours and/or the ages of children supervised and cared for can be altered upon notifying CCLD in writing of the given modifications and/or changes. The applicant reports there five (5) adults that live in the home and five (5) adults has received criminal record clearance. LPA note that at the time of inspection there was only the applicant in the home.

LPA toured the interior and exterior of the residence with the Applicant. The home consists of four (4) bedrooms, two (2) bathrooms, two closets, one (1) living room area (furnished into daycare room), dining room, kitchen, and back outdoor patio with yard. Applicant reported day care services will occur in the living room, hallway bathroom and backyard only. There is a secured gate at the entrance of the living room preventing access to the rest of the home. (See LIC812 for four (4) bedrooms).

LPA observed that the living room (furnished into daycare) and one (1) bathroom, to have plenty of spacing and ventilation for the comfort of children in care. The bathroom was clean and orderly. LPA notes there are no toxins and dangerous items in the bathroom accessible to children in care.
· The living room has a fireplace made inaccessible to children in care with a gate and furniture in front of it.
· The home has various combination carbon monoxide and smoke detector in the home. The bedroom 1 unit was tested at 9:49AM and was operable.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217156
VISIT DATE: 10/24/2024
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· LPA observed all bedrooms secured with door knob covers making them inaccessible.

· LPA notes, the applicant does have multiple sleep mats, a crib, and a playpen to meet the children’s sleeping needs.

· LPA reminded the Applicant of the importance of monitoring infants and keeping up with the infant safe sleep plan and log.

· Knives are stored in a locked elevated cabinet in the kitchen.


· Dish soap and cleaning supplies are in a locked closet and along with the rest of the household chemicals.
· Family medication is in the locked closet in the hall and inaccessible to children in care.
· LPA observed a required fire extinguisher (2A10BC) in the home on the kitchen counter with a purchase date 8/12/2024. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually.
· LPA observed a first aid kit located in the locked closet with the medication.
· Applicant stated drinking water will be supplied by the homes built in filtration system. Children will be supplied their own drinking cups.

LPA observed the back yard and patio area to be completely fenced by wood.
· LPA observed a gate separating the area un-observable where applicant stores her trash bins and yard supplies making it inaccessible to children in care. The applicant reported that children will have access to the outdoor back patio area but not past the secured gates.
· LPA observed items, equipment, toys, and furnishings for the children in care that are in good condition and age appropriate. LPA advised the Applicant to check daily for insects and animals which may pose a threat to children in care prior to children having access to play structures and toys.
· Applicant reported drinking water will be accessible by means of water bottles. Applicant stated they will use individual water cups for the children in care.
· LPA notes no bodies of water were observed.
· Applicant reported there are no guns and ammo in the home.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217156
VISIT DATE: 10/24/2024
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· LPA observed a shed that was not locked and accessible. In the shed are various outdoor cooking supplies and recreational toys for children. Applicant stated the shed will be locked by the end of business day 10/24/2024. A photo will be sent to LPA for confirmation.
LPA observed an ADU on the property.
· Two (2) adults live in the ADU. Two (2) adults have fingerprint clearance.
· LPA observed two (2) gates separating the main home from the ADU. Making the ADU inaccessible to children in care.
· The ADU has two (2) bedrooms, living room, kitchen, and one (1) bathroom.

LPA record review revealed all documents as noted below.
· Preventative Health training was complete on 8/19/2024.
· Applicant completed Mandated Reporter training which expires 10/09/2026.
· Pediatric CPR/First Aid (EMSA approved) and expires 5/26/25.
· Applicant completed FCCH orientation on 2/15/2024.
· LPA observed immunization records for all adults residing in the home. LPA reminded Applicant of obligation to maintain current training and certifications.
· Applicant does not have liability insurance for the license yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).

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, Lisette Jimenez provided proof of control of property.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217156
VISIT DATE: 10/24/2024
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APPLICANT Lisette Jimenez stated she will not provide Incidental Medical Services (IMS). 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/. http://www.ada.gov/childqanda.htm

LPA reviewed with applicant Lisette Jimenez, 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, 10/23/2024, 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; 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.

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
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217156
VISIT DATE: 10/24/2024
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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

Applicant, informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
The home meets Title 22 Division 12 requirements of a small FCCH license. License is pending LPM approval.

A notice of site visit was given to applicant Lisette Jimenez, 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, Lisette Jimenez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
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