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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566217011
Report Date: 05/15/2024
Date Signed: 05/15/2024 12:53:08 PM

Document Has Been Signed on 05/15/2024 12:53 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:VALENCIA FAMILY CHILD CAREFACILITY NUMBER:
566217011
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/15/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Maria & Alfred ValenciaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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 THIS IS A CHANGE OF LOCATION FROM 566216594.
On May 15, 2024 at 11:00 AM, Licensing Program Analyst (LPA) Laura Villanueva conducted an announced Pre-licensing inspection. Licensees and LPA toured the facility inside and outside. Licensees were not caring for children at the time of the inspection. The child care children are at the other location.

The home is a 3-bedroom, 3-bath, 2-story home. The licensees will use the living room, kitchen, hall bathroom, and backyard for the child care. The garage, three bedrooms, and 2 bathrooms will not be utilized and will be designated off limits for childcare. LPA observed a gate at the stairs making them inaccessible to children. There are age appropriate toys, teaching materials, and furnishings in good condition and free of hazards. LPA did not observe any toxins/hazardous items accessible to children. The backyard is fully enclosed with a fenced wall. Cleaning agents and disinfectants are stored under the kitchen sink with a child lock. Kitchen knives are stored out of reach. The bathroom to be used for children in care was observed to be clean.

Licensees submitted a copy of lease agreement as control of property. Because the licensees rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the licensees confirms was provided to the property owner/landlord. The licensees has obtained a signed Property Owner/Landlord Consent form (LIC9149).



A regulation 2A10BC fire extinguisher was observed with a purchase date of 05/14/2024. Licensees are reminded to service or purchase the fire extinguisher yearly. Licensees installed new smoke and carbon

CONTINUED ON LIC809C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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 4
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: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 566217011
VISIT DATE: 05/15/2024
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monoxide detector purchased 05/06/2024. LPA observed the home to be orderly. No bodies of water were observed on site. Licensee stated that there are guns and ammunition at the other licensed child care home. Guns are stored in locked TSA certified boxes separate from the ammunition.

Licensees Pediatric First Aid/CPR certificate is valid until 01/03/2025 for Alfred and 09/26/2024 for Maria. Licensees Mandated Reported Training is valid until 11/17/2025 for Maria and 01/18/2025 for Alfred.

Licensees are 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.

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) or (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.



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). Licensees was informed that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. Licensees were 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.

CONTINUED ON LIC809C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 566217011
VISIT DATE: 05/15/2024
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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.

LPA discussed the safe sleep regulations with licensees and discussed the Child Care Licensing Safe Sleep webpage at:


https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/
safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or
facility representative] 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.

On this date, May 15, 2024, 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.

Licensees were 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.

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 platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important
Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.

CONTINUED ON LIC809

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 566217011
VISIT DATE: 05/15/2024
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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 platforms.

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.

A small family child care license is effective at this address today. Licensees will maintain compliance with California Code of Regulations, Title 22, Division 12 at all times.

Exit interview conducted and report was reviewed with the licensees, Maria & Alfred Valencia.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC809 (FAS) - (06/04)
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