566215603-9-1-2021-17-CC-ARIS-C6FRW5-20210901132234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215603
Report Date: 09/01/2021
Date Signed: 09/01/2021 01:22:41 PM

Document Has Been Signed on 09/01/2021 01:22 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:	FLORES FAMILY CHILD CARE		FACILITY NUMBER:	566215603
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	09/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Lizbeth Flores		TIME COMPLETED:	01:30 PM

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On September 1, 2021 at 12:08 PM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced annual inspection. LPA met with licensee Lizbeth Flores and discussed the nature and purpose of the inspection. Together both licensee and LPA conducted a tour of the home inside and outside. There was three children in care at the time of the inspection.

The licensee uses the living room, dining room, kitchen, one restroom, and backyard for the day-care. LPA observed all bedroom doors were locked. There are no bodies of water in the home. Licensee states that there are no firearms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. In the family room, LPA observed a fireplace with a shelf in front of it preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The backyard is fully enclosed with a concrete wall. Licensee has age appropriate toys and play structures in the backyard in good condition and free of hazards. LPA observed there was ample amount of shade available for children.

The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the entrance with a service date of 3/8/2021. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 6/1/2023. Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 9/2023. The last fire drill was conducted on 5/18/2021. All required forms are prominently posted for parent's or authorized representatives in the family room.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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: FLORES FAMILY CHILD CARE	FACILITY NUMBER: 566215603
	VISIT DATE: 09/01/2021

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A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete.

LPAs spoke with licensee regarding safe sleep regulations and observed current safe sleep requirements are being met and was readily available for LPA to review.

Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

No deficiencies were cited during today's visit.

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: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC809 (FAS) - (06/04)

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