Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566202639
Report Date: 08/05/2016
Date Signed 09/02/2016 12:44:10 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:WEISS FCC AKA ROBIN'S NESTFACILITY NUMBER:
566202639
ADMINISTRATOR:WEISS, ROBIN IRENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 388-0150
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:14CENSUS: 4DATE:
08/05/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Robin Irene WeissTIME COMPLETED:
12:50 PM
NARRATIVE
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LPA Mingle made an unannounced visit in order to conduct an Annual/Random review and met with the licensee, Ms. Weiss. The purpose of the visit was discussed and together, a tour of the home was conducted. Licensee was home with 4 children and an assistant. The home uses the living room, family room, kitchen, bathroom and 3 bedrooms for the day-care. These rooms were inspected and found safe for the children during this inspection. Licensee stated that 1 bedroom is off-limit to children in care. There were no bodies of present on the premises. Ms. Weiss stated that there are no firearms kept in the home. The home has a fire place that was observed screened in the living room and inaccessible to children in care. The home has an outdoor play area that is in between the garage and the play room with a gate leading to the street. The surface was safe during this visit with adequate play equipment for children.
The home maintains a smoke detector and a carbon monoxide monitor that meet the statutory requirement. Fire extinguisher was purchased on 8/19/15. Licensee stated that she has purchased another Fire extinguisher recently from Costco but could not provide the receipt.
Licensee stated that there are no children on prescribed medications currently. Incidental Medical Services was discussed with licensee. Detergents were observed locked in the laundry closet.
Children files reviewed today were missing LIC 9224. Children immunization requirements - SB 277 were discussed with licensee. Immunization requirements for adults-SB 792 were discussed with licensee. LPA provided a copy of the bill to licensee.
All adults in the facility have obtained a criminal record clearance.
The following violations were cited today.
-Fire extinguisher
-Acknowledgement of Licensing reports
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 LIC809 and LIC 809 D.
SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: George MingleTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3


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: WEISS FCC AKA ROBIN'S NEST
FACILITY NUMBER: 566202639
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2016
Section Cited
1596.8595(c)
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A licensed child care home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.
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Licensee shall provide copies to all parents with the 8/19/15 and 9/2/16 Annual Reports LIC 809 & LIC 809D. License must have all parents sign the LIC9224 Acknowledgement of Licensing Reports and keep a copy in the child's file for 12 months.
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Licensee failed to give parents LIC 9224 Acknowledgement of Licensing Reports as required for visit conducted on 8/19/15.
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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: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: George MingleTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3


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: WEISS FCC AKA ROBIN'S NEST
FACILITY NUMBER: 566202639
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2016
Section Cited
102417(g)(1)
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Fire extinguishers and smoke detectors shall meet State Fire Marshal standards.

Licensee had one Fire extinguisher that was expired. There was another fire extinguisher which had no receipt of date of purchase.
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Licensee must purchase a new fire extinguisher by close of business today and provide the Department with a receipt. A written statement must be submitted explaining how this violation will be prevented in the future by close of business today.
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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: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: George MingleTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3