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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216151
Report Date: 10/20/2021
Date Signed: 10/20/2021 12:23:17 PM

Document Has Been Signed on 10/20/2021 12:23 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:VELAZQUEZ FCC AKA MIRYAM'S CHILD CAREFACILITY NUMBER:
406216151
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
10/20/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maryam VelazquezTIME COMPLETED:
11:30 AM
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On 10/20/21, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley made an announced Prelicensing Inspection of the abovementioned home. LPA met with Maryam Velazquez, the Applicant of the home and explained the purpose of the inspection. Applicant informed LPA of intention to operate the Family Child Care Home, when licensed, from 7:30 AM to 4:30 PM, Monday to Friday. LPA observed one child (biological) on site along with Applicant's spouse.

LPA toured the interior and exterior of the home with the Applicant. The home is a three bedroom, two and a half bath single story dwelling. Applicant stated the home’s family room, hallway bathroom and backyard patio will be used for child care, while the bedrooms, kitchen, dinning room, garage, laundry room and yards will be excluded from child care services.

LPA observed a fireplace in the family room which is screened by a metal gate. The Applicant noted the fireplace is not being used in the home.The bathroom to be used for children care was observed to be clean and free of toxins. Medication in the home is located in a secured cabinet drawer in the kitchen which is in an excluded area of care. Detergents and cleaning compounds are stored in the home laundry room which is secure and excluded from care. Additionally, the aforementioned is located in a secured cabinet underneath the sink. LPA observed carbon monoxide and smoke detectors in the home which were found to be operable. Each detector was tested at 10:35 AM. The home has appropriate heating and ventilation. LPA observed a regulation fire extinguisher on site which was serviced on 6/15/21. LPA reminded the Applicant to purchase or service a regulation fire extinguish annually, The Applicant informed LPA no firearm or ammunition is on site.

The backyard patio is made up of a wooden deck with wooden fencing. The backyard patio area used for child care is free of hazards. Additionally, no bodies of water are observed on site.

The Applicant completed Preventative Health training on 6/2/21. Further, the applicant completed
(CONT. 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2021
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: VELAZQUEZ FCC AKA MIRYAM'S CHILD CARE
FACILITY NUMBER: 406216151
VISIT DATE: 10/20/2021
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Mandated Reporter training on 4/25/21. The Applicant’s Pediatric CPR and First Aid certificate expires on 3/20/23 (EMSA approved). LPA reviewed Applicant's control of property documents. Applicant does not have liability insurance at this time. LPA informed applicant to ensure parents sign a waiver for the liability insurance. Applicant was provided LIC 282 form.

LPA observed two dogs on site. LPA received vaccinations for each dog which was current.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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 athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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 on their purchased equipment. Applicant was informed baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours.

LPA discussed AB 633 and provided Prelicensing packet to Applicant. LPA reviewed and issued the Applicant updated samples of state required forms to be kept in the children's record. LPA also discussed the effects of Lead Exposure leaflets as well as literature related to COVID 19 safeguards and best practices (RAST TA visit completed).

Applicant was made aware that it is Applicant's responsibility to know the regulations for Family Child Care Home (FCCH) which can be accessed on-line at www.ccld.ca.gov.

The home meets the requirement for a Small FCCH. License to operate a FCCH is effective today, 10/20/21.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
LIC809 (FAS) - (06/04)
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