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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566202475
Report Date: 10/30/2024
Date Signed: 10/30/2024 12:11:08 PM

Document Has Been Signed on 10/30/2024 12:11 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:WOLFE FAMILY CHILD CAREFACILITY NUMBER:
566202475
ADMINISTRATOR/
DIRECTOR:		DONNA WOLFEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 338-3990
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/30/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Donna WolfeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 10/30/24, at 9:30 am, Licensing Program Analyst (LPA) Shane Loftus conducted an unannounced Required 3 Year Inspection of the Family Child Care Home (FCCH). LPA met with Licensee, Donna Wolfe, and explained the purpose of the inspection. LPA in the company of licensee, toured the interior and exterior of the FCCH. The FCCH uses the living room, one bathroom, and backyard for child care. The remainder of the house is off limits to children. Licensee, Assistant (Alexas Fuciach), and 6 children were present at the time of inspection.

At 10:10 am, LPA noted that the 2A10 BC fire extinguisher was last serviced on 9/30/22. LPA reminded licensee the fire extinguisher needs to be either serviced or newly purchased annually. LPA observed a smoke alarm in the living room of the house. At 10:15 am, LPA noted that the FCCH does not have a carbon monoxide detector. LPA reminded Licensee of the importance of having a functional smoke and carbon monoxide detector. The bathroom used for child care is clean and orderly. Cleaning supplies are stored in a cupboard beneath the kitchen sink as well as in the garage which off limits to the children in care. Medications are stored in an elevated cupboard in the kitchen out of the reach of children. Sharps are stored on the kitchen counter which is off limits to children. The FCCH has a fire place that is covered with glass screening. The FCCH has ventilation for childcare services.

The outdoor area has plenty of shade for the children in care. The back yard is secured by concrete fencing, entry/exit points are secured. Toys and equipment observed in the FCCH are age appropriate. There are no bodies of water on the property. There are no firearms and ammunition on the property.

The FCCH has the appropriate documentation posted in the home. A sampling of the children's records was reviewed and found to be current and complete including ID and Emergency Contact Information as well as Immunization Records.

Continued on 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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Document Has Been Signed on 10/30/2024 12:11 PM - It Cannot Be Edited


Created By: Shane Loftus On 10/30/2024 at 11:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: WOLFE FAMILY CHILD CARE
FACILITY NUMBER: 566202475

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in that Assistant Alexas Fuciach did not obtain criminal record clearance prior to employment which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2024
Plan of Correction
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Licensee will submit proof to CCLD (shane.loftus@dss.ca.gov) that Assistant, Alexas Fuciach, has obtained criminal record clearance before returning to the Family Child Care Home.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Shane Loftus
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2024


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Document Has Been Signed on 10/30/2024 12:11 PM - It Cannot Be Edited


Created By: Shane Loftus On 10/30/2024 at 11:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: WOLFE FAMILY CHILD CARE
FACILITY NUMBER: 566202475

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that the Family Child Care Home does not have a carbon monoxide detector which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/13/2024
Plan of Correction
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Licensee will submit proof to CCLD (shane.loftus@dss.ca.gov) via email that a carbon monoxide detector has been installed in the Family Child Care Home.
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the Family Child Care Home did not have a newly serviced or purchased Fire Extinguisher, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/13/2024
Plan of Correction
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Licensee will submit proof to CCLD (shane.loftus@dss.ca.gov) via email that a newly serviced or purchased 2A10BC fire extinguisher is present in the Family Child Care Home.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Shane Loftus
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/30/2024 12:11 PM - It Cannot Be Edited


Created By: Shane Loftus On 10/30/2024 at 11:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: WOLFE FAMILY CHILD CARE
FACILITY NUMBER: 566202475

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that Licensee does not have current Mandated Reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/13/2024
Plan of Correction
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Licensee will submit proof to CCLD (shane.loftus@dss.ca.gov) via email of current Mandated Reporter AB1207 training.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Shane Loftus
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2024


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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: WOLFE FAMILY CHILD CARE
FACILITY NUMBER: 566202475
VISIT DATE: 10/30/2024
NARRATIVE
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 At 10:30 am, The licensee’s records were reviewed and found to be missing Mandated Reporter training; the remainder of the documents were found to be current including CPR/First Aid that expires 8/18/25. LPA reminded Licensee that Mandated Reporter AB1207 must be updated every two years. LPA also notes that the last logged disaster/fire drill was documented on 10/7/21. LPA reminded licensee that emergency drills are required every six months and needs to be documented.

At 10:40 am LPA noted that Assistant Alexas Fuciach does not have fingerprint clearance. Licensee was reminded that all adults 18 and over living or working in the home, 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.

Licensee does not provide Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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 discussed the safe sleep regulations with licensee 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 licensee 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.

Licensee was informed of the MyChildCarePlan.org website; 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 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
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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: WOLFE FAMILY CHILD CARE
FACILITY NUMBER: 566202475
VISIT DATE: 10/30/2024
NARRATIVE
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During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Today, Type A deficiency cited under Title 22 Division 12, Appeal rights provided to licensee. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents


/guardian of children in care at the facility and to parent/guardians of children newly enrolled at the
facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have
each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

Type B Deficiencies are being cited based on LPA records review pursuant to Title 22 of the CA Code of Regulations and HSC. Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

LPA provided the Licensee a Notice of Site (LIC 9213) visit which was posted in the LPA's


presence. This REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR
PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted. FAILURE TO
POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
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