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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217166
Report Date: 11/12/2024
Date Signed: 11/12/2024 12:16:33 PM

Document Has Been Signed on 11/12/2024 12:16 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:TRINIDAD FAMILY CHILD CAREFACILITY NUMBER:
426217166
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/12/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Amadelia Trinidad ChavezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 11/12/2024, at 9:40 AM, Licensing Program Analysts (LPAs) Joaquin Mendez and Fernando Hernandez conducted an announced Pre-licensing Inspection and met with Applicant, Amadelia Trinindad. LPAs informed Applicant of the nature and purpose of the inspection. The applicant informed the LPAs of the intention to maintain operating hours of a Family Childcare Home (FCCH) from 5:00 AM to 4:00 PM, Monday- Friday and Saturday operating hours from 5:AM to 1: PM. The applicant also informed LPAs of the intention to provide care for children 1 year to 13 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 two (2) adults that live in the home and two (2) adults has received criminal record clearance. LPAs note that at the time of inspection there was the applicant and her child in the home.

LPAs toured the interior and exterior of the residence with the Applicant. This is a single home. The home consists of four (4) bedrooms, two (2) bathrooms, one (1) living room area (furnished into daycare room), dining room, kitchen, and back outdoor yard with covered patio. Applicant reported day care services will occur in the living room, the first two (2) bedrooms (furnished for daycare), hallway bathroom, and part of the outdoor back yard. There is a secured gate just past the bathroom in the hall making the two (2) back bedrooms and one bedroom bathroom inaccessible to children in care. LPAs also observed a gate at the entrance of the kitchen making the kitchen and dining room inaccessible. Additionally, LPAs observed two (2) closets in the hall locked and inaccessible.

LPAs observed that the living room (furnished into daycare), two (2) bedrooms, and one (1) bathroom, to have plenty of spacing and ventilation for the comfort of children in care. The bathroom was clean and orderly. LPAs note there are no toxins and dangerous items in the bathroom accessible to children in care.
continue on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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: TRINIDAD FAMILY CHILD CARE
FACILITY NUMBER: 426217166
VISIT DATE: 11/12/2024
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· The living room has a fireplace which is secured with a children’s dresser and inaccessible to children in care.
· The home has a carbon monoxide detector which was tested at 10:06AM and functioning. The smoke detector was tested at 10:05Am and found to be functioning.

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

· LPAs 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 garage. Access is through the kitchen.
· Family medication is in an elevated cabinet and must be locked and secured preventing access to children in care.
· LPAs observed a required fire extinguisher (2A10BC) in the home in the kitchen with a purchase date 11/07/2024. LPAs reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually.

LPAs observed the back yard with covered patio area to be completely fenced with wood fencing.
· LPAs observed a shed in the back patio which stored various tools and supplies locked with a deadbolt making it inaccessible to children in care. The storage unit is also in a part of the yard separated by a gate and is locked and inaccessible.
· LPAs observed items, equipment, toys, and furnishings for the children in care that are in good condition and age appropriate. LPAs 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 a filtered water dispenser in the home and a filtered water portable unit to use throughout the day. Applicant stated they will use individual water cups for the children in care.
· LPAs notes no bodies of water were observed.
continue on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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: TRINIDAD FAMILY CHILD CARE
FACILITY NUMBER: 426217166
VISIT DATE: 11/12/2024
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Applicant reported there are no guns and ammo in the home.

LPAs record review revealed all documents as noted below.
· Applicant completed FCCH orientation on 4/29/2024.

· Preventative Health training was complete on 6/13/2024.


· Pediatric CPR/First Aid (EMSA approved) and expires 5/06/25.

· Applicant completed Mandated Reporter training which expires 6/23/2026.


· LPAs 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.

Because the applicant Amadelia Trinindad rents the home, proof of landlord notification is required. The LPAs 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).

APPLICANT Amadelia Trinindad 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

continue on LIC809C

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

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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: TRINIDAD FAMILY CHILD CARE
FACILITY NUMBER: 426217166
VISIT DATE: 11/12/2024
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LPAs reviewed with applicant Amadelia Trinindad, 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.

LPAs 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. LPAs 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, 11/12/2024, 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 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.
continue on LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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: TRINIDAD FAMILY CHILD CARE
FACILITY NUMBER: 426217166
VISIT DATE: 11/12/2024
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The home does meet Title 22 Division 12 requirements of a small FCCH license. However, there is a third adult on the rental contract. Applicant sent proof of residence with a bank statement. Applicant stated she would send a copy of driver’s license by the end of business day 11/13/2024. Proof of residence will be sent to LPA Mendez. LPA Mendez supplied his business card with all information to send the proof. License is pending LPM approval.

A notice of site visit was given to applicant Amadelia Trinindad, 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, Amadelia Trinindad in the applicant’s preferred language, Spanish.

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

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
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