Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421712407
Report Date: 07/13/2016
Date Signed 07/13/2016 12:59:39 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:CARPENTER FAMILY CHILD CAREFACILITY NUMBER:
421712407
ADMINISTRATOR:CARPENTER, JULIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 733-2204
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 13DATE:
07/13/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Julia Carpenter TIME COMPLETED:
01:05 PM
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(3) Licensing Program Analyst (LPA) Ruth Gull made an unannounced RANDOM ANNUAL visit to the home. Met with Julia Carpenter, Licensee and explained the purpose of the visit. There were 13 children present with 2 assistants. A tour of the home was made both inside and outside. The licensee uses the converted garage and one room on the lower level of the home for the day care. The Licensee also uses the kitchen on the upper level for eating only. The staircase is barricaded. There are age appropriate toys/furnishings. LPA did not observe any toxins/ hazardous items accessible to children. The regulation fire extinguisher was serviced on 02/09/16. Licensee was reminded the fire extinguisher needs to be serviced or replaced yearly. The combination smoke and carbon detector was tested and found to be operational. The Licensee uses the backyard for the day care and it is completely enclosed by a fence with gates. There are age appropriate toys/equipment. LPA reviewed the children roster and children records. Licensee and assistants have current 1st Aid/CPR certificates (Licensee's are valid until 3/25/17. The last fire/disaster drill was done on 07/13/16. LPA reviewed Incidental Medical Services (IMS) with Licensee. She states that she currently is not providing any IMS. LPA informed Licensee that if she provided IMS in the future, she would need to submit a plan regarding Incidental Medical Services to CCL within 30 days.

Licensee is reminded that she is responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov. LPA provided a Child Care Quarterly Update to Licensee.

There were no deficiencies cited during today's visit.

Licensee posted the LIC9213 (Notice of Site Visit) during the visit.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2016
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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