Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214052
Report Date: 11/15/2018
Date Signed 11/15/2018 04:13:42 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: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: 0DATE:
11/15/2018
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Julie AyalaTIME COMPLETED:
04:00 PM
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Licensing Program Manager (LPM) George Mingle and Licensing Program Analyst (LPA)
Sylvia Mendoza-Ceja met with licensee Julie Ayala. The purpose of this informal conference will be to review and discuss cited deficiencies and concerns with the operation of this licensed facility. LPA S. Mendoza-Ceja reviewed the deficiencies cited on the visit of July 13, 2018. The licensee has implemented a plan of correction since the deficiencies were cited. LPM G. Mingle reviewed and discussed the deficiencies with the licensee and how she will maintain compliance with the deficiencies cited below.

The Department of Social Services, Community Care Licensing Division has determined that
Ayala FCC aka Julie's Home Day Care violated licensing regulations pertaining to the following violations cited on July 13, 2018.

1. Personal Rights: An infant was observed sitting in a car seat propped on a chair.
2. Operation of Family Child Care Home:
  • Children's vitamins, medication, vaporizing rub, and personal items which indicated "keep out of reach of children in the kitchen, restrooms, and patio.
  • Cabinet was not secured to the wall.
  • Emergency Disaster Plan was not posted.
  • Emergency Disaster/Fire Drill was not conducted within 6 months as required.
3. Children's Records:
  • Two files were not available for review.
  • Four files were missing immunization.
  • Three files were missing consent for medical
  • There was no consent to administer Vitamin C to children in care.
4. Health and Safety:
  • There was no carbon monoxide detector in the home.
  • Verification of Immunization for Care Providers.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2018
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
VISIT DATE: 11/15/2018
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COMPLIANCE PLAN:

1. Licensee was provided with the following resources: Smart Horizons Handout, Prelicensing Readiness Guide - FCCH English and Spanish, Family Chid Care Self-Assessment Guide - English and Spanish, Disaster Planning - Self Assessment Guide - English and Spanish, Play Yard Safety - English and Spanish, Car Seat handout - Public Health, A Child Care Provider's Guide to Safe Sleep for infants - English and Spanish, FCCH - Children's Record keeping packet and Blue Cares, PIN 17-02-CCLD AB 2231 Care Facilities: Civil Penalties, including Child Care Regulations Sections 102417 Operation of a FCCH, 102423 Personal Rights, and 102395 Penalties.

2. Licensee shall submit a written plan on how she will comply with the regulations by December 4, 2018.

3. Licensee shall attend five (5) hours of training on personal rights and management of a family child care home through the Child Care Resource and Referral Agency, Smart Horizons, or CCLD child care videos and will submit in writing what she learned from the training and how you will implement the training in the day care. Submit a written statement on what was learned by December 4, 2018.

4. Licensee shall attend a FCCH orientation and submit the orientation certificate by February 14, 2019.

5. Community Care Licensing will increase frequency of site visits to the facility for 2 years to monitor compliance.

6. Licensee shall stay in compliance with Family Child Care Regulations, Title 22, Division 12 regulations at all times.

7. Upon receipt of this report, licensee shall post for 30 days and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 C.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2018
LIC809 (FAS) - (06/04)
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