566216774-12-7-2023-17-CC-SMAZ-CYAQTZ-20231207112758

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216774
Report Date: 12/07/2023
Date Signed: 12/07/2023 11:28:05 AM

Document Has Been Signed on 12/07/2023 11:28 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	SEVERIANO FCC AKA HIS LITTLE ANGELS		FACILITY NUMBER:	566216774
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/07/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Faviola Severiano		TIME COMPLETED:	11:42 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On December 7, 2023 Licensing Program Analysts (LPAs) Susana Martinez and Aaliyah Zendejas conducted and announced pre licensing inspection. LPA's met with applicant Faviola Severiano and advised her of the purpose for the inspection. Together with the applicant, LPA's toured the home inside and outside. At the time of inspection there was one other adult in the home and no children present. No bodies of water were observed at the time of inspection. Applicant denies having guns/ammunition in the home. Applicant plans on operating M-F from 6 AM- 5 PM. The two-story home has 3 bedrooms, 3 bathrooms, kitchen, living-room, dining room, backyard patio, and garage. Children will have access to the livingroom, dining room, kitchen, patio and a half bathroom located steps away from the first floor. The kitchen knives were observed to be located in a kitchen cabinet which are inaccessible to children. A regulatory 2-A-10-BC fire extinguisher was observed to be mounted in the kitchen, LPA asked for proof of purchase. Licensee states it was a relatives extinguisher and it is about 5 years old. Applicant is reminded to service or purchase the fire extinguisher yearly. Applicant states she will purchase a new fire extinguisher today. Applicant has a working carbon monoxide detector in the home. LPA observed a functioning smoke detector in the kitchen. Alarms were tested at 9:30 AM and found to be in working condition. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed. Cleaning supplies were observed to be placed in the garage which is inaccessible to children. Applicant plans on providing meals to children in care. LPA advised applicant to be cognizant of possible food allergies children may have. If food is not provided and food is brought from the children’s homes; containers shall be labeled with child’s name and properly stored or refrigerated. Applicant's Pediatric First Aid/CPR certificate is valid through 07/13/2025. Licensee was reminded to renew her certification every two years. 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. Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SEVERIANO FCC AKA HIS LITTLE ANGELS	FACILITY NUMBER: 566216774
	VISIT DATE: 12/07/2023

NARRATIVE

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The following was discussed with the applicant:
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization's, and a valid criminal record clearance associated to the facility license.

A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements was reviewed and explained.

Smoking is prohibited in a family child care home, 24/7.

Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs permitted in the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SEVERIANO FCC AKA HIS LITTLE ANGELS	FACILITY NUMBER: 566216774
	VISIT DATE: 12/07/2023

NARRATIVE

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

The applicant provided proof of control of property.

The applicant has obtained a signed Property Owner/Landlord Consent form (LIC9149).

On this date, 10/05/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

LPA discussed the safe sleep regulations with licensee 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 applicant 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's provided the following resources to Applicant:

- Entrance Checklist was provided to the applicant (LIC126)

- Infant Sleep Chart template
- Fire/Disaster Drill Log
- Pictorial Capacity Regulation
- Items not Permitted in a home.
Continued 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SEVERIANO FCC AKA HIS LITTLE ANGELS	FACILITY NUMBER: 566216774
	VISIT DATE: 12/07/2023

NARRATIVE

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Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

License is pending:

- Proof of service/purchase for regulatory fire extinguisher.

- Stove knobs/ making stove inaccessible to children in care.

- Napping equipment.

- Toys, play equipment for children.

Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

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 in Spanish with the applicant Faviola Severiano.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

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