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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215800
Report Date: 12/30/2021
Date Signed: 12/30/2021 12:58:00 PM

Document Has Been Signed on 12/30/2021 12:58 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:BAKER FAMILY CHILD CAREFACILITY NUMBER:
426215800
ADMINISTRATOR:JAMEE BAKER/LEGALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 937-1490
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jamee BakerTIME COMPLETED:
01:00 PM
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On 12/30/2021, LPA Reyes conducted an unannounced comprehensive required inspection. LPA asked pre screening questions related to COVID 19. Licensee's responses indicate there was no exposure on site. LPA met with Licensee, Jamee Baker and discussed the purpose of the inspection. There were 4 children present, 2 of whom are Licensee's grandchildren.

The home was toured inside and out. LPA observed required Licensing forms are posted by the wall in teh day care area. LPA observed a 2A10BC fire extinguishers with a service date of 10/6/2021. Carbon monoxide and smoke detectors were tested and found functional . LPA observed age appropriate toys and furniture readily accessible to children in care. The backyard is completely fenced with age appropriate toys and equipment. Licensee stated there are no fire arms nor ammunition in home. The home is kept clean and in order. Toxins and hazardous items are kept inaccessible to children in care.

LPA reviewed facility file, CPR and first aid expires on 2/6/2023. Licensee has a complete record of immunization per SB 792. LPA reviewed children's records and found complete with Identification and Emergency Information card. Based on document reviewed, Licensee checks and documents the napping infant every 15 minutes. LIC 9227 Infant Individual Sleep Plan was completely filled out and signed. LPA discussed the COVID 19 mitigation and the safe sleep plan with licensee.

No deficiencies were cited during today's inspection.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2021
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: BAKER FAMILY CHILD CARE
FACILITY NUMBER: 426215800
VISIT DATE: 12/30/2021
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Licensee is not providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

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 [email protected]. 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/process.

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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021
LIC809 (FAS) - (06/04)
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