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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566209616
Report Date: 05/26/2022
Date Signed: 05/26/2022 02:00:05 PM

Document Has Been Signed on 05/26/2022 02:00 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CISNEROS FAMILY CHILD CAREFACILITY NUMBER:
566209616
ADMINISTRATOR:MARIA CISNEROSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 585-9701
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
05/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria CisnerosTIME COMPLETED:
12:30 PM
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On May 25, 2022 at 10:30AM, Licensing Program Analyst (LPA) Betzayra Cervantes conducted an unannounced visit to conduct a Required - 1 Year inspection. LPA spoke to licensee Maria Cisneros and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. One fingerprint cleared adult was also present during the inspection. Licensee and LPA toured the facility inside and outside. Licensee and assistant were caring for nine children at the time of the inspection.

The home is a five bedroom, three bath two story home. LPA observed a safety gate at the side of the kitchen and the front entrance of family room in the back, making the second floor inaccessible to the children in care. Licensee states that there are no firearms and ammunition in the home. LPA observed a screened fireplace in both the living room and family room preventing children from having access. LPA did not observe toxins/hazards accessible to children in care. The bathroom was observed to be clean and sanitary. There are age appropriate toys and furniture readily accessible to children. The backyard has two complete separate areas. These two areas are separated by a large fence. One side is for the children and the other side is made inaccessible to children with a gate and contains licensee's three dogs. LPA reminded licensee it is her responsibility to ensure the safety of children when playing with pet animals. Licensee reported that the dog's vaccinations are up to date. Licensee has age appropriate toys and play structures in the backyard in good condition and free of hazards.

All adults in the home are fingerprint cleared. LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher was observed mounted in the kitchen with a service date of 01/04/2022. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed the home to be orderly. No bodies of water were observed on site. No toxins nor hazards are accessible to children in care. Detergents and cleaning compounds are stored out of reach of children. LPA observed a carbon monoxide and smoke alarm detector which were tested and found to be operable.

CONTINUED ON 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2022
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CISNEROS FAMILY CHILD CARE
FACILITY NUMBER: 566209616
VISIT DATE: 05/26/2022
NARRATIVE
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Review of licensee's CPR and First Aid certification revealed she completed the course online which is not approved by the Department or EMSA certified. Licensee is to submit proof of an EMSA approved Pediatric First Aid/CPR certification to CCLD. Record review also reveals that licensee does not have AB 1207 Mandated Reporter Training certificate on file. Licensee last completed a disaster drill on 04/21/22. All required forms including Notification Of Parent's Rights are prominently posted for parent's or authorized representatives to view. A roster of children in care was observed current and complete. A sampling of children records were reviewed and LPA observed Identification and Emergency Notification forms (LIC 700) and a copy of immunization records on file.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

CONTINUED ON 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
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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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CISNEROS FAMILY CHILD CARE
FACILITY NUMBER: 566209616
VISIT DATE: 05/26/2022
NARRATIVE
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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.

Deficiencies are being cited based on observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, refer to LIC 809-D. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report and appeal rights were reviewed with the licensee, Maria Cisneros.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/26/2022 02:00 PM - It Cannot Be Edited


Created By: Betzayra Cervantes On 05/26/2022 at 01:18 PM
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: CISNEROS FAMILY CHILD CARE
FACILITY NUMBER: 566209616

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2022

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 licensee interview and record review, the licensee did not have Mandated Reporter training certificate on file for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/10/2022
Plan of Correction
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Licensee is to submit proof of Mandated Reporter certification to CCLD by 06/10/2022.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee interview and record review, the licensee's CPR and Fist Aid certification revealed she completed the course online which is not approved by the Department or EMSA certified which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/10/2022
Plan of Correction
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Licensee is to submit proof of an EMSA approved Pediatric First Aid/CPR certification to CCLD by 06/10/2022.
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:George Mingle
LICENSING EVALUATOR NAME:Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022


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