566216624-6-7-2023-17-CC-SMAZ-CSKP6Z-20230607110309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216624
Report Date: 06/07/2023
Date Signed: 06/07/2023 11:03:16 AM

Document Has Been Signed on 06/07/2023 11:03 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:	GARCIA CLEMENTE FCC AKA GRACE FCC		FACILITY NUMBER:	566216624
ADMINISTRATOR:	SALUSTIA GARCIA-CLEMENTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 366-9520
CITY:	OXNARD	STATE: CA	ZIP CODE:	93035
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	06/07/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	SALUSTIA GARCIA-CLEMENTE		TIME COMPLETED:	11:18 AM

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This is a change of location, previous license number was 566215871.

On 06/07/2023, Licensing Program Analyst (LPA) Susana Martinez conducted an announced change of location, Pre-licensing inspection for a Large Family Child Care Home (FCCH) license. LPA met with Salustia Garica Clemente, applicant of the FCCH and discussed the purpose of today’s visit. LPA and Applicant together toured the inside and outside of the home. There were no children in care at the time of the inspection. Licensee plans to operate Monday to Saturday from 4:30 am to 5 pm.

Applicant requested a change of location for a large family childcare license. The home is a one-story home with three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining area, garage and outdoor yard. LPA notes that the day care services will occur in the living room, dining area, kitchen, one (1) bathroom, and enclosed backyard. Meanwhile, the three (3) bedrooms, one (1) bathroom located inside the master bedroom and garage will be off-limits to children in care. LPA notes, the door that leads to the garage has a door safety knob as well as the three (3) rooms off-limits.

LPA observed the FCCH is fully equipped to meet the needs of children in care. LPA observed that the FCCH is clean and orderly. In addition, there is plenty of ventilation for the children in care. LPA did not observe any toxins nor hazards items accessible to children in care. LPA observed that knives are stored in a high kitchen cabinet making them inaccessible to children in care. Cleaning chemicals and toxins were observed to be located in a top kitchen cabinet out of reach for children in care. The bathroom to be used for children in care was observed to be clean and free of toxins.

CONT 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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: GARCIA CLEMENTE FCC AKA GRACE FCC	FACILITY NUMBER: 566216624
	VISIT DATE: 06/07/2023

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LPA observed a regulation 3A10BC fire extinguisher located in the kitchen at the time of the inspection that was purchased on 05/13/2023. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed applicant test a combination smoke and carbon monoxide detector in the home at 9:45 AM and was functioning at the time of the inspection.

Applicant stated that there are no weapons or ammunition in the home. No bodies of water were observed at the time of inspection. Applicant's Pediatric First Aid/CPR certificate is valid until 09/2023. Applicant’s Mandated Reporter Training certificate is valid until 09/09/2024. Control of property was verified via receipt of mortgage deed. Applicant received fire clearance from Oxnard Fire Department on 5/30/2023. LPA observed a small breed dog, applicant provided proof of vaccines. Vaccines are up to date.

LPA discussed Incidental Medical Services with the licensee. Incidental Medical Services (IMS) policy was discussed. 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: htttp://www.ada.gov/childqanda.htm

LPA provide a pictorial ratio/capacity sheet to licensee and reminded her that without the presence of an assistant, the capacity reverts back to the requirements of a Small Family Child Care.

This home meets Title 22 Division 12 requirements of a Large FCCH license. Effective date of license will be noted as the present, 06/07/2023.

No deficiencies cited during this visit. Exit interview and review of report was conducted with applicant, Salustia Garica Clemente in Spanish due to Spanish being applicant’s primary language. 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: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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