Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214052
Report Date: 04/18/2016
Date Signed 04/18/2016 10:45:12 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:AYALA FCC AKA JULIE'S HOME DAY CAREFACILITY NUMBER:
426214052
ADMINISTRATOR:JULIE AYALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 737-3040
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 8DATE:
04/18/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Julie AyalaTIME COMPLETED:
10:50 AM
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(3) Licensing Program Analyst (LPA) Ruth Gull made an unannounced RANDOM ANNUAL visit to the home. Met with Julie Ayala, Licensee and explained the purpose of the visit There were 8 children present and Licensee's husband was assisting. The home was toured both inside and outside. Licensee uses the living room, play room and 2 hall bathrooms for the day care. One bedroom is used for napping only. There are age appropriate toys/furnishings. The regulation fire extinguisher was purchased on 10/2/15. Licensee was reminded the fire extinguisher needs to be serviced or replaced yearly. The combination smoke detector/carbon monoxide detector was tested and found to be operational. LPA did not observe any toxins/hazardous items accessible to children. The backyard is used for the day care and it is completely enclosed by a fence with gate. There are age appropriate toys and equipment. LPA reviewed the children roster and children records. Licensee's 1st Aid/CPR certificates are valid until 01/14/17. The last fire/disaster drill was done on 12/6/15. Licensee states that there are no guns/weapons on the property. 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 of operation regarding Incidental Medical Services to CCL within 30 days. LPA did not observe any bodies of water on the premises. Licensee has a small dog (license/vaccines are current).

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) in LPA's presence.

SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2016
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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