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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216374
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:11:42 PM

Document Has Been Signed on 09/28/2022 03:11 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:KOL FAMILY CHILD CAREFACILITY NUMBER:
426216374
ADMINISTRATOR:BOTTA KOLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 242-2628
CITY:SANTA BARBARASTATE: CAZIP CODE:
93103
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Botta KolTIME COMPLETED:
03:15 PM
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On September 28th, 2022 at 1:30PM, Licensing Program Analyst (LPA) Rosie Breault conducted an announced inspection for the purpose of performing a pre-licensing inspection. LPA asked applicant pre-screening questions related to COVID-19. Applicant's responses to the pre-screening questions suggest no COVID-19 exposure on site.

LPA met with applicant Botta Kol and discussed the purpose of the inspection. LPA and applicant together toured the interior and exterior of the home. Applicant is sole resident of family childcare home (FCCH).

During this tour the following was noted:

Per applicant, the operating hours will be Monday through Friday from 7:30AM-6:00PM

All areas identified on the facility sketch were inspected. This is a single story home which consists of two (2) bedrooms, four (4) living rooms, two (2) restrooms, one (1) reading room, one (1) attic, kitchen, and outdoor play area. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Off limit areas included: 2 bedrooms and attic are excluded from childcare services.

CONT. ON LIC809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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: KOL FAMILY CHILD CARE
FACILITY NUMBER: 426216374
VISIT DATE: 09/28/2022
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Applicant stated that children will have access to the 4 living rooms, both restrooms, reading room, kitchen, and outdoor play area.

There are age appropriate toys and napping equipment on the premises. Outdoor play area has ample shade for children and all gates are securely locked. Applicant has a first aid kit and emergency supplies secured, locked and out of reach to children. Knives and medication for the family are stored out children’s reach, inaccessible to children and locked. Inaccessible rooms (2 bedrooms and attic entrance) have secured pin activated locks. No bodies of water present. No fireplace present.

The required fire extinguisher 2A10BC was purchased on 8/8/2022. Combination Smoke detector and carbon monoxide detector was tested at 1:50PM and was functioning at the time of the visit. Per applicant, there are no firearms present in the home.

The applicant completed the FCCH Orientation on 9/28/2022. The applicant has current Pediatric First Aid and CPR which expires 6/2/2024. Applicant completed the Mandated Reporter Training on 6/2/2022. Fire clearance was granted 8/10/2022.

LPA reviewed with applicant the LIC311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

CONT. ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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: KOL FAMILY CHILD CARE
FACILITY NUMBER: 426216374
VISIT DATE: 09/28/2022
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LPA discussed the safe sleep regulations with applicant, provided applicant with Safe Sleep Information handout, 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 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The home meets Title 22 Division 12 requirements of a large FCCH license.

Currently, applicant does not have Preventative Health and Training; however, has provided proof of registration for course on 10/9/2022. Applicant to provide copy of certificate to LPA on completion.

Provisional license has been granted effective 9/28/2022.

An exit interview was conducted and report reviewed with applicant.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
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