Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214343
Report Date: 03/09/2017
Date Signed 03/09/2017 04:03:34 PM

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:SIMONIAN FCC AKA HOPE FAMILY CHILD CAREFACILITY NUMBER:
406214343
ADMINISTRATOR:ROBIN ROSE SIMONIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 888-9504
CITY:PISMO BEACHSTATE: CAZIP CODE:
93449
CAPACITY:14CENSUS: 7DATE:
03/09/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Robin SimonianTIME COMPLETED:
04:10 PM
NARRATIVE
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(1) Licensing Program Analyst (LPA) Maria Mueller conducted an annual random visit and met with licensee, Robin Simonian. LPA observed children playing outdoors. The backyard is completely fenced, LPA observed small play structure, bikes, shade area, bike area, tables and chairs. The living room and the dining room area are used for day care. The fireplace is completely fenced. The bedrooms are used for napping. LPA observed age appropriate toys, books, games, play kitchen, tables and chairs
The smoke alarm / carbon monoxide detector was tested and was found operational. The fire extinguisher was purchased January 29, 2017. Sampling of children's record reviewed. Safety drills were not conducted and documented, last drill was conducted July 2016. Licensee and her assistant are not current with immunization requirements per SB 792.
Licensee is not providing Incidental Medical Services. 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 made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed online at www.cdss.ca.gov.

Reporting, posting, and record keeping requirements were discussed. AB 633 and AB 978 explained to licensee. Licensee has been advised that baby bouncers, walkers, exersaucers are not permitted in a licensed family child care home.
In the areas evaluated, deficiencies cited under Title 22 Division 12. Appeal rights given.

LPA observed licensee post the Notice of Site visit.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2017
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: SIMONIAN FCC AKA HOPE FAMILY CHILD CARE
FACILITY NUMBER: 406214343
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2017
Section Cited
102417 g 9 A 1
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Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.

Licensee did not conduct safety drill and document the drill every six months, last drill conducted July 2016.
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Licensee stated that she will submit proof of correction by March 20, 2017.
Type B
03/20/2017
Section Cited
§1597.622(a)1
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Employees or volunteers at family day care home; immunization requirements; records; exemptions. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licensee stated that she will submit proof of correction by March 20, 2017.
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Licensee states that she does not have proof of immunization against influenza, pertussis, and measles.
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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: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2017
LIC809 (FAS) - (06/04)
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