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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566217084
Report Date: 07/25/2024
Date Signed: 07/25/2024 02:30:32 PM

Document Has Been Signed on 07/25/2024 02:30 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
566217084
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
07/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Mirna RodriguezTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Change of Location, old facility number: 566216064

On 07/25/2024 at approximately 12:19pm, Licensing Program Analyst (LPA) David Roman and Veronica Diaz conducted an announced change of location. Licensee and LPA's toured the facility both inside and outside to assess for safety and health hazards. Prior to the change of location inspection, Licensee contacted LPA's via telephone to inform if they could conduct the home inspection tour while caring for two children. LPA's contacted LPM A. Tolentino for approval of inspection while Licensee is in care of two children.

At the time of inspection Licensee was caring for 2 children at the time of the inspection. The home is a 3-bedrooms, 2-bathrooms, and 1 garage, home. The Licensee will use the living room, dining room, 1 bathroom, and backyard for the childcare. The garage, 3 bedrooms, 1 bathrooms will not be utilized and will be designated off limits for childcare. LPA's observed a screened fireplace in the living room inaccessible to children. The applicant provided proof of control of property. LPA's 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 sink and in the garage which have child safety locks and child gate preventing their access. Kitchen knives are stored out of reach of children, the kitchen is blocked off by child gate. The bathroom to be used for children in care was observed to be in the hallway, clean and sanitary.

A regulation 2A10BC fire extinguisher was observed with a purchase date of 07/25/2024. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA's had applicant test smoke and carbon monoxide detector which were found operational. LPA's reminded Licensee of the need to conduct fire/carbon testing and evacuations every 6 months.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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 3
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 566217084
VISIT DATE: 07/25/2024
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LPA's inquired if any firearms or ammo is in the home. LIcensee reported no firearms nor ammo stored in the home. All adults in the home are fingerprint cleared. Upon assessing the front yard a knife was found in the gardening area in which LPA's informed Licensee to discard or store in an area inaccessible to children. Licensee discarded the knife. LPA's observed the home to be orderly. No bodies of water were observed on site.

LIcensee's Pediatric First Aid/CPR certificate is valid until 03/2025. Licensee's Mandated Reported Training is valid until 04/05/2025.

Licensee 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.

Licensee reported that the facility does not provide Incidental Medical Services (IMS) to any children in their care. The 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.

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.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 566217084
VISIT DATE: 07/25/2024
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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-andresources/
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.

On this date 07/25/2024, 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.

A small family child care license is effective today.



Exit interview conducted and report was reviewed with the Licensee, Mirna Rodriguez.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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