566217060-10-11-2024-17-CC-AZES-D9XQGX-20241011121016

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566217060
Report Date: 10/11/2024
Date Signed: 10/11/2024 12:10:28 PM

Document Has Been Signed on 10/11/2024 12:10 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	TARVER & TIEBEN FAMILY CHILD CARE		FACILITY NUMBER:	566217060
ADMINISTRATOR/ DIRECTOR:	TARYN TARVER SKYLAR TIEBEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 553-5581
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/11/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Skylar Tiben and Taryn Tarver		TIME VISIT/ INSPECTION COMPLETED:	12:35 PM

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 October 11, 2024 @ 9:30 AM, Licensing Program Analyst (LPA) Aaliyah Zendejas conducted an announced Inspection for the purpose of performing a pre-licensing inspection. LPA Zendejas met with Taryn Tarver and Skylar Tieben, Applicants and discussed the purpose of the Inspection. LPA Zendejas and Applicants together toured the interior and exterior of the home. The home is a three bedroom, two bathroom, single story home.

All adults in the home are fingerprint cleared. 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.

During this tour the following was noted:
Applicant applied for a Large Family Child Care license. There are 2 adults residing in the home. The home has received a fire clearance from the Venture County Fire Department as of 10/04/2024.
Per Applicant, the operating hours will be Monday through Saturday 24 hours a day. Applicant states she wants to care for children from 0 months to 12 years old.

All areas identified on the facility sketch were inspected. This is a single-story home which consists of three
bedrooms, two bathrooms, a front living room, kitchen, as well as a basement under ground level. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The backyard is enclosed and has age appropriate toys. LPA noticed two sheds in the backyard that were locked, held extra supplies and will be out of reach of children.

CON'D ON 809-C

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

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

FACILITY NAME: TARVER & TIEBEN FAMILY CHILD CARE	FACILITY NUMBER: 566217060
	VISIT DATE: 10/11/2024

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
26
27
28
29
30
31
32

LPA observed a regulation 2A10BC fire extinguisher in the FCCH at the time of the inspection that has a service date of February 14, 2024. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed applicant test a combination smoke and carbon monoxide detectors in the home at 09:51 AM and were functioning at the time of the inspection. Applicant stated that there are no weapons or ammunition in the home. LPA observed first aid kits in all day care rooms.

Applicants are current with immunization required per SB 792. Applicants completed the Orientation on 14 and 16 of June 2023. Applicant's Pediatric First Aid/CPR certificate is valid until July 8, 2025. Applicants completed the Preventative Health & Safety on July 09, 2023. Applicant’s Mandated Reporter Training certificate is valid until June 15 and June 16 2025. The applicants, provided proof of control of property. Control of property was verified via receipt of lease agreement. Because the applicant, rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

On this date, October 11, 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice .

LPA observed that knives are stored in an elevated and locked cabinet in the kitchen inaccessible at the time of the inspection. Cleaning compounds were observed in both a locked closet that is in a bathroom inaccessible to children and in a cabinet underneath the sink that was locked at the time of the inspection making the cleaning compounds inaccessible to children in care. The bathroom to be used for children in care was observed to be clean and free of toxins. LPA observed child size furniture and material for activities throughout the home in areas that will be accessible to children in care.

LPA observed the exits to be secured. LPA observed there is shading to afford the children in care. In addition, Filtered water will be accessible by means of individual bottle water. The play area has age-appropriate toys and day-care equipment. LPA and applicant discussed active supervision when children are in the outdoor yard.
CON'D ON 809-C

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: TARVER & TIEBEN FAMILY CHILD CARE	FACILITY NUMBER: 566217060
	VISIT DATE: 10/11/2024

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
26
27
28
29
30
31
32

No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

· All adults living and working in the home shall be made of aware of the Department inspection rights authority.

(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 are available at: https://www.ada.gov/resources/child-care-centers/.

Forms to be posted
LIC6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License

Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse,
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).

Children ’s records requirements: LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children in Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

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. Applicant was made aware the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

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.

CON'D ON 809-C

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: TARVER & TIEBEN FAMILY CHILD CARE	FACILITY NUMBER: 566217060
	VISIT DATE: 10/11/2024

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
26
27
28
29
30
31
32

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-andresources/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 of infant devices or their purchased equipment.

The home meets Title 22 Division 12 requirements of a Large FCCH license. Effective date of license will be noted as October 11, 2024.

A notice of site visit was given to applicant 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 with the applicants, Taryn Tarver and Skylar Tieben.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4