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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216301
Report Date: 05/13/2022
Date Signed: 05/13/2022 11:29:43 AM

Document Has Been Signed on 05/13/2022 11:29 AM - 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:CABRERA FAMILY CHILD CAREFACILITY NUMBER:
566216301
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
05/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Julia CabreraTIME COMPLETED:
11:45 AM
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On May 13, 2022 at 9:37 AM, Licensing Program Analysts (LPAs) Betzayra Cervantes and Susana Martinez conducted an announced Pre-licensing inspection. LPA spoke to applicant Julia Cabrera and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Applicant and LPA toured the facility inside and outside. Applicant her spouse were caring for their own child at the time of the inspection.

The home is a four bedroom, three bath two story townhouse. The applicant will use the living room, dining room which is being utilized as the main playroom, one bathroom, and back patio for the day-care. On the first floor, the pantry and garage are off limits to children in care. LPAs observed a child safety gate at the bottom of the stairs making the second floor inaccessible. The second floor is not used for day-care and is off limits to children. There are age appropriate toys, teaching materials, and furnishings in good condition and free of hazards. The back patio is fully enclosed with a fenced wall. Applicant has age appropriate toys in the patio readily accessible to children. LPAs observed a child size trampoline in the backyard with a child safety net around it. Licensee was advised to stay within the manufacturers requirements for the trampoline. LPAs advised licensee that she must provide visual supervision at all times while the children are playing outside in the backyard and on the trampoline. LPAs did not observe any toxins/hazardous items accessible to children. LPAs observed a storage shed in the patio which is secured and inaccessible to children. The bathroom to be used for children in care was observed to be clean and sanitary.

LPAs did not observe any toxins/hazardous items accessible to children. A regulation 3A10BC fire extinguisher was observed with a purchase date of 05/10/2022. Applicant is reminded to service or purchase the fire extinguisher yearly. LPAs had applicant test dual smoke and carbon monoxide detector in the home and were found operational. All adults in the home are fingerprint cleared. LPAs observed the home to be orderly. No bodies of water were observed on site. Applicant stated that there are no guns or ammunition in the home. Detergents and cleaning compounds are stored out of reach of children. Medication in the FCCH is made inaccessible to children in care. Toxins and cleaning compounds are also secured.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
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 3
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: CABRERA FAMILY CHILD CARE
FACILITY NUMBER: 566216301
VISIT DATE: 05/13/2022
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Applicant's Pediatric First Aid/CPR certificate is valid until 05/07/2024. Applicant's Mandated Reported Training certificate is valid until 02/20/2023. LPA reviewed lease agreement to verify control of property. Preventative Health and Safety and Nutrition Training completed on 02/27/2021. Applicant states the home does not currently have liability insurance. LPA informed applicant that parents will need to sign a waiver for the liability insurance if insurance is not obtained (applicant was provided form- LIC 282).

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.html

LPA issued the applicant updated samples of state required forms to be kept in the children's records. LPA also discussed and provided Guidelines to Safe Sleep and Effects of Lead Exposure leaflets. Applicant was provided information from PIN 20-24-CCP - Recently Approved Safe Sleep Regulations In Effect and LIC 9227 (Infant Sleeping Plan). Applicant was informed that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. Applicant was made aware of the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.



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.

Applicant 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: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
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: CABRERA FAMILY CHILD CARE
FACILITY NUMBER: 566216301
VISIT DATE: 05/13/2022
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LPA discussed the safe sleep regulations with applicant 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.

LPA reviewed COVID-19 guidelines/resources with applicant (RAST Technical Assistance Visit completed). LPA also reminded licensee to continue monitoring the CCLD website for COVID-19 updates and guidance. Applicant will implement pre-screening checks, promoting prior hand washing and continuously disinfecting throughout the day.



License to operate a Small Family Child Care facility is effective today, 05/13/2022. Once licensed, the licensee is required to comply with the terms and limitations stated on the license. Document Link Icon

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed in Spanish with applicant, Julia Cabrera.

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

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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