Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566202639
Report Date: 08/17/2017
Date Signed 08/17/2017 05:09:29 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: 6DATE:
08/17/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:44 PM
MET WITH:Weiss, Robin IreneTIME COMPLETED:
05:15 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. Robin Weiss. The purpose of the visit was discussed and a tour of the home was conducted. Licensee was caring for 6 children, together with an aide. Children were observed napping upon arrival.
There were no bodies of water present on the premises. Licensee stated that there were no firearms kept at the home. The home has a fireplace which was observed blocked off by a doll house.
The home uses the day-care, kitchen, 2 bedrooms, the family room and the living room for the day-care. LPA toured these areas and found them free of hazards. Detergents and cleaning compounds were observed locked in a cabinet in the day-care room. Kitchen knives and cutting objects were stored on top of the fridge. The home has a 2A10BC fire extinguisher with no receipt. Licensee stated she had the receipt was posted but was unable for find it during this visit. The home was free of litter. There were no stairs observed at the home.
The home has a fully fenced play yard in front of the house and a backyard . Licensee conducts and logs fire and emergency drills. Last drill was conducted on 3/6/2017. Licensee and her assistant have partially satisfied immunization requirements for providers. Licensee's assistant needs a booster for Tdap. Licensee needs to submit proof of TDap. Licensee stated she will provide evidence to the Department by 9/17/2017.
Licensee's CPR/First aid certification was current and will expire on 4/5/2019. All adults in the home have obtained a criminal background clearance. Children files inspected had immunization records but C1. Licensee stated that there were no children on medication currently. Licensee maintains an updated roster for the children in care.
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)
SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: George MingleTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2017
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 4


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
VISIT DATE: 08/17/2017
NARRATIVE
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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 deficiencies were cited today:
- Operation of a family child care home
- Immunization

See attached LIC809D.

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: 08/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2017
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: 08/17/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/17/2017
Section Cited
102417(g)(1)
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Fire extinguishers and smoke detectors shall meet State Fire Marshal standards.


There was a 2A10BC fore extinguisher without a receipt.
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Licensee shall submit a copy of receipt for a fire extinguisher to the Department by close of business 8/18/2018.
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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: 08/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2017
LIC809 (FAS) - (06/04)
Page: 3 of 4


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: 08/17/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2017
Section Cited
102418(g)
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Licensee shall document and maintain each child's immunization as long as the child is enrolled.


C1 had no immunization on file.
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Licensee shall obtain and update immunization for C1 and submit proof to the Department by close of business 8/24/2017.
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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: 08/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2017
LIC809 (FAS) - (06/04)
Page: 4 of 4