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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216151
Report Date: 10/19/2022
Date Signed: 10/19/2022 03:36:58 PM

Document Has Been Signed on 10/19/2022 03:36 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: 5DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Miryam VelazquezTIME COMPLETED:
12:00 PM
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On 10/19/22, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an announced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA also notes the Inspection is to address a change of capacity request. LPA met with Miryam Velazquez, the Licensee of the home and explained the purpose of the inspection. LPA observed five child (two biological) in care during the time of the inspection.

LPA toured the interior and exterior of the home with the Licensee. The FCCH's family room, hallway restroom and backyard patio are used for child care, while the bedrooms, kitchen, dinning room, garage, laundry room and front yards are excluded from child care services. The FCCH is clean and orderly. LPA observed a fireplace in the family room which is screened by a metal gate. Licensee informed LPA the fireplace is not being used. The restroom to be used for children care is 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, cleaning compounds are 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 11:30 AM. LPA observed a regulation fire extinguisher (2A10BC) on site which was purchased on 10/19/22. LPA reminded the Licensee to purchase or service a regulation fire extinguish annually, Toys and play equipment observed in the FCCH are age appropriate. The Licensee 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. Toys and play equipment observed in the backyard patio are age appropriate. LPA observed no bodies of water on site. LPA observed to adult trampolines on the property in excluded area. LPA reminded the LIcensee the aforementioned should not be used by children or used during hours of operation.
(CONT. LIC 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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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: 10/19/2022
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LPA reviewed children and staff records during the inspection. Children's records are current and complete with immunization records, emergency contact forms and sleep logs, among other things. The Licensee's record are also current and complete. Licensee's Mandated Reporter training expires on 4/25/23 and Pediatric CPR and First Aid certificates expires on 3/20/23 (EMSA approved). LPA notes the last fire drill was completed on 8/10/22. Two dogs are on site. LPA reviewed vaccination records for the dogs and found the vaccinations to be 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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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-and-resources/safe-sleep as an for 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.

LPA notes a fire clearance for the FCCH was received on 10/13/22, from the he San Luis Obispo County Fire Department granting a capacity of 14. The FCCH is sufficient for a Large FCCH and as such a License for a capacity of 14 is granted forthwith (10/19/22).

A Notice of Site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Miryam Velazquez.

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

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC809 (FAS) - (06/04)
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