Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566202639
Report Date: 11/26/2018
Date Signed 11/29/2018 04:30:36 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: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:
11/26/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Robin Weiss and Tristin ElizaldeTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ana Tolentino made an unannounced Annual Inspection and met with Licensee Robin Weiss and Assistant Tristin Elizalde. The purpose of the inspection was discussed and together we tour the home inside and outside. Licensee and Assistant present today with six children.
The home is one story home, 5 bedroom, kitchen, dinning room, living room, backroom, two bathrooms and fenced backyard. The Licensee states their is no firearms or ammunition in the home. LPA did not observe any bodies of water during the visit. Kitchen knives and other items which could pose danger to children are stored inaccessible to children. Fire extinguisher is a 2A10BC, last purchased 09/18/2018. Fireplace is properly screened. The home has a smoke and carbon monoxide detector. Licensee has all required forms posted for parents to view. The home provides safe toys, play equipment and materials. The children have safe and comfortable accommodation. Last fire and disaster drills conducted 07/16/2018. CPR/First Aid certificate is current for the Licensee with an expiration date of 11/2020 and Assistant with expiration date of 05/2020. Licensee states all individuals living or working at home have criminal record clearance. SB792 Adult Immunization and AB1207 Mandated Reporting Training on file. Children's files reviewed, Child#6 missing LIC700 I.D and Emergency Information form.
Incidental Medical Services (IMS) was discusses and Licensee states she currently does not have any children with IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Today, deficiencies cited under Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D). Appeal Rights provided

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ana TolentinoTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2018
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: WEISS FCC AKA ROBIN'S NEST
FACILITY NUMBER: 566202639
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2018
Section Cited
CCR
102421(b)
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102421(b) Childs Records. The licensee shall maintain, in each child’s record, a copy of the emergency information card required in Section 102417(g) (7).
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Licensee will submit in writing how she will maintain children's records for day-care children with required forms on file.
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This violation was evidenced by the licensee's failure to have Child#6's ID/Emergency Information form available. This poses a potential hazard for children.
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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: Ana TolentinoTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2018
LIC809 (FAS) - (06/04)
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