Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426211932
Report Date: 12/14/2016
Date Signed 12/14/2016 01:45:35 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:BERNAL FAMILY CHILD CAREFACILITY NUMBER:
426211932
ADMINISTRATOR:TOMASA BERNALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 562-8124
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:14CENSUS: 4DATE:
12/14/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Tomasa BernalTIME COMPLETED:
02:00 PM
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(2) Licensing Program Analyst (LPA) Maria Mueller conducted an annual random visit and met with licensee, Tomasa Bernal. LPA informed licensee the reason for the visit. The home was toured inside and outside. The living room, one bedroom and play room are used for day care. The kitchen is gated, the cabinets in the kitchen are locked with tot locks. The fireplace is blocked with a play kitchen. The bathroom is clean and free of toxins. The outdoor play area is completely fenced, LPA observed age appropriate toys, slide, swing, small plastic play houses, grass area, bike area and shade area. There are 3 dogs in the property. There are no bodies of water observed.
There is a functioning carbon monoxide that meets statutory requirements. The smoke alarm was tested and was found operational. The fire extinguisher was serviced March 14, 2016. Licensee is current with CPR and First Aid which expires August 2018. The fire drill was conducted and documented, last drill was conducted
June 2016. Licensee stated that there are no guns or ammunition in the home.
Licensee stated that she 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
Children's roster reviewed. Child's file reviewed.
In the areas that were evaluated, no deficiencies were observed at the time of the visit.

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: 12/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2016
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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