Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215157
Report Date: 12/13/2018
Date Signed: 12/13/2018 01:32:21 PM

COMPREHENSIVE INSPECTION
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:MORENO FAMILY CHILD CAREFACILITY NUMBER:
426215157
ADMINISTRATOR:EMILY ANNE MORENOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 736-3247
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 7DATE:
12/13/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Emily MorenoTIME COMPLETED:
01:40 PM
NARRATIVE
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A Comprehensive Unannounced Required - 3 Year inspection was conducted by LPA S. Mendoza-Ceja who met with Licensee Emily Moreno and her two assistants who were caring for seven (7) children The home was toured inside and outside. Licensee stated there are no firearms/ammunition or bodies of water on the premises. LPA did not observe any bodies of water on the premises. There is an operating dual carbon monoxide/smoke detector in the home. There is a 2 A10 BC Fire Extinguisher purchase 10/24/2018. Licensee was reminded to service or replace the fire extinguisher yearly. The last emergency drill was conducted on 11/14/2018. LPA reviewed children's records, including the child care roster. LPA reviewed the handout "A Child Care Provider's Guide to Safe Sleep". Licensee Emily Moreno and Marilyn Silbaugh both have current CPR and First Aid (expire 9/2/2019) .

LPA discussed AB 1207 Child Abuse Mandated Reporter Training required by the Department.
LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. Licensee was also advised each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or waiver signed.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any 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

According to CCR, Title 22, Division 12, the following Type B deficiencies are cited on pages #2. Appeal Rights were reviewed. LPA observed the "Notice of Site Visit" posted.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2018
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 426215157
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2018
Section Cited
HSC
1596.8662(b)(1)
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1596.8662(b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years
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Please submit verification to Licensing for review by
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following the date on which he or she completed the initial mandated reporter training. --The requirement was not met based on interview with Licensee. Licensee stated she and her two assistants have not completed AB 1207 Child Abuse Mandated Reporter Training which poses a potential health and safety risk to children in care.
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Type B
12/21/2018
Section Cited
HSC
1597.622(a)(1)
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1597.622(a)(1) Health and Safety Employees or volunteers at family day care home; immunization requirements; records; exemptions. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
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Please submit verification to Licensing for review by 12/21/2018
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Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
--This requirement was not met as evidenced by the Licensee's failure to obtain verification of immunizations for Licensee and her two assistants which poses a potential risk to the safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2018
LIC809 (FAS) - (06/04)
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