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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214060
Report Date: 06/08/2022
Date Signed: 06/08/2022 04:28:10 PM

Document Has Been Signed on 06/08/2022 04:28 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:VASQUEZ FAMILY CHILD CAREFACILITY NUMBER:
566214060
ADMINISTRATOR:SUSIE VASQUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 279-7401
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Susie VasquezTIME COMPLETED:
04:45 PM
NARRATIVE
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On June 8, 2022 at 1:00 AM, Licensing Program Analysts Dean Thompson and Susana Martinez conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with licensee Susie Vasquez and advised the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There were two day care children in care at the time of the inspection along with licensee, licensee husband and two adults that are not associated to the facility.

When LPA's arrived, LPA's were denied access to the home and licensee stated children in care were related and belonged to friends. Licensee stated she has been closed since last year 2021. Licensee stated she did not notify Community Care Licensing Department (CCLD) of the closure and did not mail in her original license. LPA asked licensee for a written statement stating she was no longer interested in providing care so that LPA's can make note of the facility closure. Licensee then allowed LPA's to conduct the annual Inspection. Licensee stated she didnt want licensing inside the home since she had family visiting and that is why she stated she was closed.

LPA observed the required licensing documents were not visible in a publicly accessible area while children are in care. Documents were observed in a 3 ring binder. Fire and earthquake drills are not being documented every six months. Fire extinguisher 2A10BC was last serviced on 1/15/2021. Licensee was reminded to purchase or service the existing fire extinguisher once a year. Fire and carbon monoxide detectors were tested and working.

Children in care have access to living room, dining room, and one restroom. Licensee stated the back yard is not being used at this time for children in care.

Continued on LIC 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
Document Has Been Signed on 06/08/2022 04:28 PM - It Cannot Be Edited


Created By: Dean Thompson On 06/08/2022 at 03:07 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 566214060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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, interview, and record review, the licensee did not comply with the section cited above. LPA observed 2A10BC fire extinguisher underneath the kitchen sink. Fire extinguisher was last serviced on 1/15/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2022
Plan of Correction
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Licensee agreed to purchase or service the existing fire extinguisher by POC due date.

In informal conference will be scheduled at a later date.
Type B
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

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. LPA observed makeup products, hydrogen peroxide, and shaving razors inside the childrens restroom which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2022
Plan of Correction
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Licensee agreed to remove items from restroom that can be a potential safety risk to children in care.
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:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 06/08/2022 04:28 PM - It Cannot Be Edited


Created By: Dean Thompson On 06/08/2022 at 03:07 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 566214060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. Licensee was unable to provide a copy of the emergency disaster plan which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2022
Plan of Correction
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Licensee agreed to provide LPA a copy of the emergency disaster plan and have it available for review by POC due date.

An informal conference will be scheduled at a later date.
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:George Mingle
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 06/08/2022 04:28 PM - It Cannot Be Edited


Created By: Dean Thompson On 06/08/2022 at 03:07 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 566214060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

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. During record reviews, licensee stated she did not have documentation showing she was conducting fire and disaster drills every six months. LPA observed the last drill being documented September 2019 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2022
Plan of Correction
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Licensee agreed to provide LPA with documentation showing drills are being conducted every six months by POC due date.

An informal conference will be scheduled at a later date.

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:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 06/08/2022 04:28 PM - It Cannot Be Edited


Created By: Dean Thompson On 06/08/2022 at 03:07 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 566214060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2022

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 observation, interview, and record review, the licensee did not comply with the section cited above. Licensee was unable to provide proof of her mandated reporter certification AB1207 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2022
Plan of Correction
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Licensee agreed to complete the mandated report training by POC due date and provide proof to LPA.

An informal conference will be scheduled at a later date.
Type B
Section Cited
CCR
102391(b)
Inspection Authority of the Department
(b) The licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care
laws or regulations. The Department shall exercise this authority as specified in Health and Safety Code
Section 1596.8535(a).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA's were denied access to the home to conduct an annual inspection. Licensee stated she has been closed since 2021 but later admitted she only stated that because she had family visiting and did not want LPA's there which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2022
Plan of Correction
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An informal conference will be scheduled at a later date.
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:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 06/08/2022 04:28 PM - It Cannot Be Edited


Created By: Dean Thompson On 06/08/2022 at 03:07 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 566214060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 observation, interview, and record review, the licensee did not comply with the section cited above. Licensee stated she did not have a current Firstaid/CPR certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2022
Plan of Correction
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Licensee agreed to provide LPA proof of certification by POC due date.

An informal conference will be scheduled at a later date.
Section Cited
Deficient Practice Statement
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3
4
POC Due Date:
Plan of Correction
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4
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:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022


LIC809 (FAS) - (06/04)
Page: 6 of 7
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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 566214060
VISIT DATE: 06/08/2022
NARRATIVE
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Inside the restroom being utilized for children in care, LPA observed makeup products, hydrogen peroxide, and shaving razors. There are no bodies of water present at the time of inspection. Licensee stated there are no firearms or ammunition on the property.

LPA reviewed two out of two children files. All children files were current. Licensee did not have a current CPR/first aid or mandated reporter certification. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com

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/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.

Licensee advised there were no children in care that required Incidental Medical Services. 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

There were seven Type B deficiencies cited during todays inspection.

A notice of site visit was given 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 licensee Susie Vasquez

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC809 (FAS) - (06/04)
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