426217232-1-21-2025-17-CC-JMEZ-DD5QZ5-20250121113610

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426217232
Report Date: 01/21/2025
Date Signed: 01/21/2025 11:36:29 AM

Document Has Been Signed on 01/21/2025 11:36 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	DIAZ FAMILY CHILD CARE		FACILITY NUMBER:	426217232
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/21/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Yolanda Diaz		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/21/2025, at 9:40 AM, Licensing Program Analysts (LPAs) Joaquin Mendez and Fernando Hernandez conducted an announced Pre-licensing Inspection and met with Applicant, Yolanda Diaz. 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 5:00 PM, Monday- Friday. The applicant also informed LPAs of the intention to provide care for children 0 to 12 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 three (3) adults that live in the home and three (3) adults has received criminal record clearance. LPAs note that at the time of inspection there was the applicant in the home with her two (2) adult children. LPAs toured the interior and exterior of the residence with the Applicant. This is a single-story home. The home consists of three (3) bedrooms, two (2) bathrooms, one (1) living room area, dining room, kitchen, separated garage, and outdoor backyard. Applicant reported day care services will occur in the living room, the (1) bathroom, kitchen, dining room, and part of the back-outdoor area are all accessible. LPAs note, the three (3) bedrooms, one (1) bathroom, garage will be inaccessible to children in care. Additionally, LPAs note that the outdoor back yard will be segmented off by a fence separating the children in care with the family pets (2 dogs). LPA observed a locked shed. The applicant stated she did not have access. Applicant’s spouse is the only person with a key. Once applicant’s spouse returns from work photos will be taken of the inside of shed and will be sent by the end of business day 02/01/2025 and sent to LPA Hernandez email Fernando.Hernandez@dss.ca.gov. Continued on LIC 809-C Page 2

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

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: DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 426217232
	VISIT DATE: 01/21/2025

NARRATIVE

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LPAs observed that the living room, kitchen, dining room, (1) bathroom, and back outdoor yard 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.
· The living room has a fireplace made inaccessible to children in care with a metal mesh screen cover and a wooden gate on the fireplace making it inaccessible to children.
· The home has a carbon monoxide and Smoke detector that was functioning at 9:49 AM.

· LPAs note, the applicant does not have sleep cots or mats, there is a pack n’ play to meet the infant’s children’s sleeping needs. Applicant stated she will purchase beds and send proof once they arrive to email provided by the end of business day 02/01/2025 and sent to LPA Hernandez’s email Fernando.Hernandez@dss.ca.gov.

· 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 cabinet above refrigerator making them inaccessible.

· Dish soap and cleaning supplies are in a locked cabinet under the kitchen sink and inaccessible.
· Family medication is in the applicant’s bedroom, locked and secured making them inaccessible to children.
· LPAs observed a required fire extinguisher (2A10BC) in the home in the pantry with a purchase date 1/21/2025. LPAs reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually.
· Applicant stated drinking water will be supplied by purchase of water bottles.

LPAs observed the outdoor play yard area to be completely fenced with wood fencing.
· LPA notes no bodies of water were observed.
· LPA notes that the outdoor backyard is segmented off by a fence on the northeast side of the outdoor backyard and inaccessible to the children. Inaccessible area is secured for the family pets (2 dogs).
· LPAs observed a shed in the accessible area that is locked. In the shed are various tools which belong to the husband. LPAs note the shed was locked and applicant did not have a key. Applicant stated once spouse arrives from work. Photos would be taken and sent to LPA Hernandez to email provided (Fernando.Hernandez@dss.ca.gov) and sent by end of business day 02/01/2025.

Continued on LIC 809-C Page 3

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

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: DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 426217232
	VISIT DATE: 01/21/2025

NARRATIVE

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LPAs record review revealed all documents as noted below.
· Applicant completed FCCH orientation on 10/21/2024.

· Preventative Health training was complete on 06/22/2024.

· Pediatric CPR/First Aid (EMSA approved) and expires 03/30/26.

· Applicant completed Mandated Reporter training which expires 05/13/2026.

· LPAs observed immunization records for all adults residing in the home. LPAs reminded Applicant of obligation to maintain current training and certifications.
· Applicant does not have liability insurance for the license yet. LPAs 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, Yolanda Diaz provided proof of control of property.

APPLICANT, Yolanda Diaz stated she will think about 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

LPAs reviewed with applicant Yolanda Diaz, 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.

Continued on LIC 809-C Page 4

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

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: DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 426217232
	VISIT DATE: 01/21/2025

NARRATIVE

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No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

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. 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, 01/21/2024, 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.

Continued on LIC 809-C Page 5

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

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: DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 426217232
	VISIT DATE: 01/21/2025

NARRATIVE

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The home does not meet Title 22 Division 12 requirements of a small FCCH license. Corrections must be made prior to approving license.
1. Cots must be purchased, and photos sent confirming arrival to the FCCH.
2. Outdoor play backyard has a shed which is locked and must be inspected for toxic and hazardous items which could pose harmful to children in care.
Corrections needed will be sent to LPA Hernandez at email Fernando.Hernandez@dss.ca.gov. Applicant stated she will have corrections completed by the end of business day 02/01/2025.

A notice of site visit was given to applicant Yolanda Diaz, 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 and translated by LPA Hernandez to the applicant, Yolanda Diaz in her preferred language, Spanish.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025

LIC809 (FAS) - (06/04)

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