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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214955
Report Date: 09/09/2022
Date Signed: 09/10/2022 12:11:13 PM

Document Has Been Signed on 09/10/2022 12:11 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:VILLA FCC AKA THE KIDZ KOMPANYFACILITY NUMBER:
406214955
ADMINISTRATOR:HAYDEE VILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 714-9559
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/09/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Haydee Villa TIME COMPLETED:
05:15 PM
NARRATIVE
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On 09/09/22 at 3:00 PM, Licensing Program Analyst (LPA) Francisca Velazquez made an unannounced Case Management inspection at the abovementioned Family Child Care Home. LPA met with Licensee, Haydee Villa and advised her the purpose of the inspection. LPA notes that there were eleven (11) children being supervised only by Licensee.

At 3:08 PM, in the restroom that is used by the children, LPA observe a bottle of Dawn soap accessible to children in care. LPA observed that both kitchen gates were open and not locked or secured and therefore toxins (Tide, detergent, Downey, cleaning compounds) were accessible to children in care. Outdoors, LPA observed what appeared to be large chewing dog bones in the outdoor yard accessible to children in care.

At 3:27 PM, Spouse/Assistant arrived at the facility along with his child.

Today, deficiencies are being cited under Title 22 Division 12, Appeal rights were given.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.



An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Licensee. A copy of this report was provided to the Licensee, whose signature is on this form confirms receipt of this document.

Licensee was provided a copy of their appeal rights (LIC 9058). The LIC 9213 (Notice of Site visit) was provided and must remain posted for 30 days..

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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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Document Has Been Signed on 09/10/2022 12:11 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 09/09/2022 at 04:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: VILLA FCC AKA THE KIDZ KOMPANY
FACILITY NUMBER: 406214955

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2022
Section Cited
CCR
102416.5

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102416.5 Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidence by:
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Licensee reports understanding ratios and states that she today is just a bad day. Licensee agrees this is not acceptable. Licensee agrees to submit written plan detailing how she will operate in capacity to LPA Pedroza via email to [email protected] by 9/12/22 (next business day).
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During today's inspection, LPA observed Licensee providing care and supervision to eleven (11) children. This is an immediate risk to the health and safety of the children.
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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:Maria Mueller
LICENSING EVALUATOR NAME:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/10/2022 12:11 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 09/09/2022 at 04:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: VILLA FCC AKA THE KIDZ KOMPANY
FACILITY NUMBER: 406214955

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2022
Section Cited
CCR
102417(g)(4)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (4) Poisons, detergents, cleaning compounds, medicines...pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
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Licensee agrees to removed all toxins immediately and placed in areas that are not accessible to children. Licensee understands the importance of safety gates being locked and secured at all times. Licensee agrees to write a statement on how Licensee plans to comply with this regulation and submit via email to [email protected] by 9/16/22.
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Based on LPAs observation during tour LPA observed various cleaning compounds, detergents, laundry softner, large dog bones accessible to children in care due to off-limit areas and gates not secured and/or locked, making these items accessible to chidlren in care. This is a potential risk to the health and safety to the 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:Maria Mueller
LICENSING EVALUATOR NAME:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


LIC809 (FAS) - (06/04)
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