Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426211932
Report Date: 06/28/2018
Date Signed 06/28/2018 09:54:26 AM

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: 7DATE:
06/28/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Tomasa and Maria BernalTIME COMPLETED:
10:00 AM
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An annual random was conducted by LPAs S. Mendoza-Ceja who met with Licensees Maria and Tomasa Bernal. The home was toured inside and outside. The home was observed to be clean and orderly and furnished appropriately for young children. Licensee stated there are no firearms, ammunition or bodies of water on the premises. LPA did not observe any bodies of water. LPA observed safety latches on the cabinets in the kitchen and making cleaning agents inaccessible. The restroom designated for the children is located near the kitchen. The backyard was observed to have various toys for young children. The 2A1BC Fire Extinguisher was serviced on 05/09/2018. There is smoke detector and carbon monoxide detector in the home. Children's records were reviewed. LPA reviewed “A Child Care Provider’s Guide to Safe to Sleep” handout with Licensee. Licensees Maria Bernal (expires 08/20/2018) and Tomasa Bernal (expires 03/11/2019) both have current CPR and First Aid.
LPA reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA reviewed verification of immunizations at the visit.
LPA the required AB 1207 Child Abuse Mandated Reporter Training.

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

No deficiencies cited. The "Notice of Site Visit" was posted at the visit.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2018
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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