566217228-11-19-2024-17-CC-FHEZ-DB6Q67-20241119105305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566217228
Report Date: 11/19/2024
Date Signed: 11/19/2024 10:54:47 AM

Document Has Been Signed on 11/19/2024 10:54 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:	LUPIAN FAMILY CHILD CARE		FACILITY NUMBER:	566217228
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	11/19/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Alberto Lupian		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

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On 19 November 2024, at 09:00 AM, Licensing Program Analysts (LPAs) Aaliyah Zendejas and Fernando Hernandez conducted an announced Pre-licensing inspection. LPAs informed the Applicant, Alberto Lupian, about the purpose of the inspection and together toured the facility inside and outside. Applicant was not caring for children at the time of the inspection. Applicant stated childcare will be provided Monday through Friday, 24 hours a day. LPA Zendejas provided applicant with the regulations regarding overnight care. Applicant wishes to provide childcare for children ages 0 to 13 years.

The home is a 3- bedroom, 2 -bath, home. The applicant will use the living room, one bathroom, and enclosed backyard for childcare. Inaccessible areas will be the garage, all 3 bedrooms, kitchen, dining area, and one bathroom as listed in facility sketch as designated area off limits for childcare. LPAs did not observe a fireplace within the home. LPA did not observe any toxins/hazardous items accessible to children in the facility today. The backyard is fully enclosed with a fenced wall. LPAs observed two doors on the side of the house that open up to the front yard. LPAs advised applicant to add a lock out of reach of children so children are unable to access the front yard. Cleaning agents and disinfectants are stored within the garage that is accessible by the bathroom that children have access to. LPA advised applicant to add a lock on the door of the garage to ensure that it is inaccessible to children in care. Applicant stated that they would soon be adding a gate to the kitchen area so children are unable to access the kitchen. Kitchen knives are stored out of reach of children. The bathroom to be used for children in care was observed to be clean, sanitary and free of toxins/hazardous items accessible to children.

A regulation 2A10BC fire extinguisher was observed with a purchase/service date of October 8, 2024. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA had applicant test smoke and carbon monoxide detector which were found operational at 09:37 AM. All adults in the home are fingerprint cleared. LPA observed the home to be orderly. No bodies of water were observed on site. Applicant stated that there are no guns or ammunition in the home.

CON'D ON 809-C

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Fernando Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

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: LUPIAN FAMILY CHILD CARE	FACILITY NUMBER: 566217228
	VISIT DATE: 11/19/2024

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Applicant's Pediatric First Aid/CPR certificate is valid until 05/24/2026. Applicant's Mandated Reported Training is valid until 08/07/2026. Preventative Health and Safety and Nutrition Training was completed on 08/22/2024. Childcare orientation was completed on 03/05/2024.

Applicant provided proof of control of property.

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 (LIC9149)

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.

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 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, 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. CON'D ON 809-C

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Fernando Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

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: LUPIAN FAMILY CHILD CARE	FACILITY NUMBER: 566217228
	VISIT DATE: 11/19/2024

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LPAs reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.
LPA provided the applicant updated state required forms to be kept in the children's records.

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

Applicant was 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.

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.

On this date November 13, 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.

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: Fernando Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

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: LUPIAN FAMILY CHILD CARE	FACILITY NUMBER: 566217228
	VISIT DATE: 11/19/2024

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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-carelicensing/
subscribe and select the Child Care option to receive email communication.

Small Family Child Care home licensing is pending the following corrections:

- Applicant is to add a lock or made garage inaccessible to children
- Applicant is to add locks on the doors of the gate on the outside of the home
- Applicant is to make kitchen inaccessible.

A notice of site visit was given to applicant, Alberto Lupian and must remain posted on, or immediately adjacent to, the interior of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant, Alberto Lupian.

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Fernando Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

LIC809 (FAS) - (06/04)

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