Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214052
Report Date: 07/13/2018
Date Signed 07/13/2018 04:52:16 PM

COMPREHENSIVE INSPECTION
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: 11DATE:
07/13/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Julia and Oscar AyalaTIME COMPLETED:
05:10 PM
NARRATIVE
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An annual random was conducted by LPA S. Mendoza-Ceja who met with Licensee Julie Ayala and her husband Oscar Ayala. Upon arrival, Licensee Julie Ayala escorted LPA to the backyard/patio area where LPA observed infant #1 sitting strapped in a car seat eating which was propped on a chair. LPA advised licensee Ayala this was not appropriate. Licensee removed the infant #1 from the car seat immediately and placed infant #1 in an infant chair to eat at the table. LPA observed eight (8) children outside playing on the patio. Licensee stated there were three (3) other school age children in the house in the day care room. LPA inspected the patio and backyard, LPA observed Kirkland's Children's Vitamin C accessible above a drawer (plastic) . LPA was advised they give the Vitamin C to the children. LPA asked if they had written permission. Licensee stated she did not have written permission, but the parents are aware. The Vitamin C was observed to be within reach of young children. LPA advised the Vitamin C needs to be at least 5 feet or higher. Licensee removed the Vitamin C from the patio area. Licensee escorted LPA through the home. LPA inspected two restrooms accessible to children and observed Vaporizing Rub accessible in the restroom, including other items which indicate" keep out of reach". When LPA tested a latch on a cabinet placed on the back of the toilet, the cabinet almost fell and was observed to be not secured to the wall which poses a hazard for children in care. In the kitchen, LPA observed various medications stored accessible in cabinet (under 5 feet). Mr. Ayala escorted LPA to the front yard where the older children play. LPA observed various toys available in the front and backyard area. LPA observed a trampoline and requested the manufactures directions to ensure it is used for the appropriate age group. Licensee's did not have the information available for review. Licensee stated there are no firearms, ammunition or bodies of water on the premises. LPA did not observe any bodies of water. The 2 A10 BC Fire Extinguisher did not a service/or purchase date; however the gauge was observed to be green. Mr. Ayala left to purchase a new one during the visit. The is operational smoke detector in the home. The child care roster was reviewed. LPA reviewed “A Child Care Provider’s Guide to Safe to Sleep” handout with Licensee. The last emergency drill was conducted on December 6, 2017. Licensee's CPR and First Aid is current (expires 04/05/2019). LPA reviewed 9 children's files and two files were not available for review.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2018
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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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: AYALA FCC AKA JULIE'S HOME DAY CARE
FACILITY NUMBER: 426214052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/13/2018
Section Cited
CCR
102417(g)
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102417(g) Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child.
--The above regulation was not met as evidenced by the Licensee failure to ensure
cabinet placed on top of the toilet was not secured to the wall which might have endangered a child in care.
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The cabinet was removed from the restroom and placed in the garage.

Please submit a plan to Licensing for review.
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When LPA tested a latch on the cabinet placed on the toilet, the cabinet almost fell and was observed to be not secured to the wall which poses an an immediate Health, Safety, or Personal Rights risk to children in care
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Type A
07/14/2018
Section Cited
HSC
1597.543
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§1597.543 Carbon monoxide detectors required; inspection Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12.
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Please submit verification of a carbon monoxide detector for the home by 07/14/2018
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--The above regulation was not met as evidenced by the Licensee failure to obtain a carbon monoxide detector for the home.

There is no carbon monoxide detector inthe home which poses an an immediate Health, Safety, or Personal Rights risk to children in care
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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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2018
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: AYALA FCC AKA JULIE'S HOME DAY CARE
FACILITY NUMBER: 426214052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/13/2018
Section Cited
CCR
102423(a)(2)
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102423(a)(2) Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment.
--Based on observation by LPA the Licensee failed to accord a safe, healthful and comfortable accomodations, furnishings and equipment for infant #1.
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Licensee removed infant #1 from the car seat and placed the infant an appropriate infant chair at the table.

Please submit a plan to Licensing for review.
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Upon arrival, Licensee Julie Ayala escorted LPA to the backyard/patio area where LPA observed infant #1 sitting strapped in a car seat eating which was propped on a chair. Licensee was advised this poses an immediate Health, Safety, or Personal Rights risk to children in care
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Type A
07/14/2018
Section Cited
CCR
102417(g)(1)
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102417(g)(4) Operation of a Family Child Care Home. Poisons... medicines...and other items which could pose a danger to children shall be stored where they are inaccessible to children.
--Based on observation by LPA the Licensee failed to make medication and items that indicate "keep out of reach" inaccessible to day care children.
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Please correct Immediately and submit a plan to Licensing for review.
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LPA observed Children's Kirkland Vitamin C accessible to children, Vaporizing Rub, including other personal items which indicate" keep out of reach" accessible to children. In the kitchen, medications was stored in a cabinet (not 5 feet) which were accessible to day care children.Licensee was advised this poses an immediate Health, Safety, or Personal Rights risk to children in care
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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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2018
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: AYALA FCC AKA JULIE'S HOME DAY CARE
FACILITY NUMBER: 426214052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2018
Section Cited
CCR
102417(g)9(A)1
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102417(g)(9)(A)(1) 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.

The above regulation was not met as evidenced by the Licensee failure to ensure to the fire drill was completed. In addition,
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Please submit verification to Licensing by July 18, 2018.
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licesee failed to have the Emergency Disaster Plan (LIC610A) posted.

The last fire drill was conducted on 12/6/2017. There was no Emergency Disaster Plan posted which poses a potential risk to children in care.
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Type B
07/30/2018
Section Cited
CCR
102421
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102421 Child's Records
Children's Files were reviewed and found to be incomplete.
--This was evidenced by Licensee Ayala's failure to have the required documents.
-Review of 9 of 11 files were available and revealed two children's files were missing and the 9 were incomplete. The files were missing signed Parent's Right's
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Please have files complete by 07/30/2018.
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forms from 9 files. Immunizations were missing from 4 files. Consent for Medical from missing 3 files. Consent for Medical missing from 3 files. In addition, there is was no consent from parents allowing licensee to administer Vitamin C to children. Licensee was advised this poses a potential risk to children in care.
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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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2018
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: AYALA FCC AKA JULIE'S HOME DAY CARE
FACILITY NUMBER: 426214052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/13/2018
Section Cited
CCR
102417(g)(1)
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102417(g)(1) Fire extinguishers and smoke detectors shall meet State Fire Marshal standards.

The above regulation was not met as evidenced by the Licensee failure to ensure to the 2 A10 BC Fire Extinguisher is current prior to the visit by Licensing.
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During the visit, Mr. Ayala left to purchase a new 3 A10 BC Fire Extinguisher.
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The 2 A10 BC Fire Extinguisher did not a service/or purchase date; however the gauge was observed to be green. Licensee was advised this poses a potential risk to children in care.
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Type B
07/27/2018
Section Cited
HSC
1597.622(a)1
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1597.622(a)1Health and Safety: 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
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Please submit verificaiton to Licensing for review.
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receive an influenza vaccination between August 1 and December 1 of each year.
-The above regulation was not met as evidenced by licensee's failure to have verification available for review.
There was no verificaiton for licensee and Oscar Ayala which poses a potential risk to children in care.

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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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2018
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: AYALA FCC AKA JULIE'S HOME DAY CARE
FACILITY NUMBER: 426214052
VISIT DATE: 07/13/2018
NARRATIVE
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LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. Licensee did not have verification available for review. LPA discussed AB 1207 Child 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

The following Type A and B deficiencies were cited according to CCR, Title 22, Division 12.
Appeal Rights were provided to Licensee.

The Notice of Site Visit and Type A violations shall be posted for 30 days. Licensee is to provide a copy of this report to each parent/legal guardian of every child for the next 12 months. Every parent/guardian must sign a LIC 9224 , "Acknowledgment of Licensing Reports" and place a copy of this document in each child's file for the next 12 months.

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: 07/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2018
LIC809 (FAS) - (06/04)
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