566216213-1-10-2022-17-CC-ARIS-CAJUWJ-20220110145650

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216213
Report Date: 01/10/2022
Date Signed: 01/10/2022 02:57:00 PM

Document Has Been Signed on 01/10/2022 02:57 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:	566216213
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/10/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Erika Flores		TIME COMPLETED:	03:07 PM

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On January 10, 2022, at 1:05 PM Licensing Program Analyst (LPA) Austin Rios conducted an announced visit for the purpose of completing a pre-licensing inspection. LPA met with Applicant Erika Flores and explained the nature and the purpose of the inspection. Applicant provided LPA a tour of the home inside and out. The home is a 4 bedroom, 3 bath two story residence. Applicant will be using the living room, dining room, kitchen, one bathroom downstairs, back-yard, and a alternate playroom upstairs with one bathroom upstairs. All other bedrooms are off limits with a lock and the garage has a lock. LPA observed a gate at the bottom of the stairs and top of the stairs preventing children from having access.

LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher purchased on January 8, 2022 was observed in the kitchen. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA observed the home has a functioning smoke and carbon monoxide detectors. There were age appropriate toys in the home. LPA observed the home to be clean and orderly. Applicant stated they do not have firearms and ammunition in the home. Detergents and cleaning compounds are stored out of reach of children. The bathrooms to be used for children in care was observed to be clean and sanitary. The backyard has a concrete wall around it. LPA observed sufficient amount of shade for children to have access to.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022

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: FLORES FAMILY CHILD CARE	FACILITY NUMBER: 566216213
	VISIT DATE: 01/10/2022

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Preventative Health & Safety and Nutrition Training completed on 10/19/2023. Applicant First Aid/CPR certificate is valid until 10/21/2023 . Applicant AB 1207 Mandated Reporter Training Certificate expires 10/21/2023. Currently the applicant does not have liability insurance and will be looking into getting some. LPA informed applicant that she will need parents to sign a waiver for the liability insurance should she not have the liability insurance. Applicant provided proof of control of property. LPA discussed and verified SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). Applicant was informed walkers, bouncers, and any similar object that restricts children's movement is prohibited from licensed facilities.

LPA reviewed, discussed and gave applicant updated samples of state required forms to be kept in the children's file, required forms to be posted, and forms that needs to be maintained at the Family Child Care Home (FCCH). LPA discussed information about Sudden Infant Death Syndrome, Never Shake a Baby, and Capacity requirements. LPA discussed Safe Sleep regulations with applicant. Applicant was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov.

Applicant advised to monitor the CCLD website for COVID- 19 updates and guidance.
LPA reviewed Covid-19 resources with applicant (RAST Technical Assistance Visit completed).

LPA advised applicant to contact Child development Resources at (805) 485 7878

License to operate a Family Child Care facility is effective today 1/10/2022.

A copy of this report was reviewed and provided to the applicant. Notice of Site visit posted (LIC9213).

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022

LIC809 (FAS) - (06/04)

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