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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212437
Report Date: 06/22/2022
Date Signed: 06/22/2022 03:47:13 PM

Document Has Been Signed on 06/22/2022 03:47 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:GODINEZ FAMILY CHILD CAREFACILITY NUMBER:
566212437
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
06/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:44 PM
MET WITH:Maria godinezTIME COMPLETED:
04:01 PM
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On 6/22/2022, Licensing Program Analyst (LPA) Austin Rios met with Licensee Marisol Godinez and explained the purpose of the inspection. LPA conducted a Pre-screening with licensee prior to entering the home. Licensee had three child in care at the time of the inspection. Together the LPA and licensee toured the home inside and outside.

The licensee uses the family room, play room, kitchen, one restroom, and backyard for the day-care. LPA observed a gate preventing access to the upstairs and into the dining room There are no bodies of water in the home. On 6/9/2022 Ventura County Fire Department conducted an inspection. Fire-Clearance for large facility was granted. The 2A10BC regulation fire extinguisher was observed in the play room with a service date of 7/30/2021. Toxins and hazards are inaccessible to the children. There are age appropriate toys and day-care equipment in the home. The back yard has age appropriate toys and day-care equipment. LPA advised licensee must provide visual supervision while the children are playing both inside the home and outside in the backyard. Licensee stated that there are no firearms or ammunition in the facility. First Aid/CPR certificates is valid until 8/9/2022.

LPA discussed and verified SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). was informed walkers, bouncers and any similar object that restricts children's movement are prohibited from licensed facilities.

Cont. on 809C.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2022
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: GODINEZ FAMILY CHILD CARE
FACILITY NUMBER: 566212437
VISIT DATE: 06/22/2022
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 LPA reminded Licensee of the child care regulations for infants and to continue monitoring the CCLD website at www.ccld.ca.gov for updates.

Facility license will be a large family childcare effective today, June 22,, 2022 for a capacity of 14 children.

A copy of this report was reviewed and provided to the licensee.

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: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
LIC809 (FAS) - (06/04)
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