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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 147700006
Report Date: 03/24/2023
Date Signed: 03/24/2023 02:01:51 PM


Document Has Been Signed on 03/24/2023 02:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:TAMMIE AND SCOTT CHISMFACILITY NUMBER:
147700006
ADMINISTRATOR:Tammy&Scott ChismFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 873-7574
CITY:BishopSTATE: CAZIP CODE:
93514
CAPACITY:14CENSUS: 7DATE:
03/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tammie ChismTIME COMPLETED:
02:00 PM
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On 3.24.23, Licensing Program Analyst (LPA) Kris Diaz conducted an unannounced Annual inspection. LPA met with Licensee, Tammie Chism who guided LPA on a tour of the home. People who reside in the home are the licensees, Tammie and Scott Chism who have fingerprint clearance. The licensees have the required immunizations against pertussis (TDAP), measles (MMR) and have provided a signed statement declining the flu vaccine. LPA advised that co-licensee, Scott Chism is required to provide proof of vaccine or declination. 7 childcare children were present. Per the licensee the family childcare home operates Mon-Fri 8:00am-5:00pm. Incidental Medical Services (IMS) were discussed. Per the licensee, she does not have children who need IMS currently. Per licensee, has not provided care for more than 8 children in over 10 years and would like to change capacity to Small FCCH.

This is a one-story family home. The home consists of three bedrooms, two bathrooms, playroom, dining room, living room, kitchen, patio, laundry room, and backyard. The primary care for children will be conducted in the playroom, living room, kitchen, and bathroom #1 located in the laundry area. Children will have access to the entire home. There is a television in the living room that should be anchored to the wall. The living room has a fireplace that has a gate surrounding it making it inaccessible to the children. LPA observed toys and books in childcare room appropriate for children. Per licensee, parents provide napping equipment for children. LPA observed 2 pack n plays for napping, a picnic style table for dining, one highchair, and two boosters for infant feeding. The dining area has a fireplace that has a gate surrounding it making it inaccessible to children. Per licensee, there are no children with food allergies in care currently. LPA reminded licensee that food provided by parents should be properly labeled and stored. LPA observed licensee place sharp objects and knives in upper cabinet making inaccessible to children. LPA advised licensee to put a safety latch on cabinets containing sharp objects and cleaning supplies.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kristina DiazTELEPHONE: (661) 202-3372
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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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Document Has Been Signed on 03/24/2023 02:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: TAMMIE AND SCOTT CHISM
FACILITY NUMBER: 147700006

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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LPA advised Licensee, Scott Chism complete Mandatory Reporter Training by POC due date and provide proof of completion to department.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2023
Plan of Correction
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LPA observed licensee write statement of declination
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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kristina DiazTELEPHONE: (661) 202-3372
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TAMMIE AND SCOTT CHISM
FACILITY NUMBER: 147700006
VISIT DATE: 03/24/2023
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There are no off-limits areas in the home. All bedrooms used for napping only. LPA reminded licensee that 100% supervision always required. LPA advised licensee to place safety knobs on doors when rooms not in use during childcare operation hours. The home has a large backyard contains a playhouse and other age-appropriate toys. LPA observed two grills with covers making inaccessible to children. LPA observed an inoperable truck used for storage that contains a cover making inaccessible to children. LPA reminded licensee 100% supervision required when playing outside in this area. Per licensee, backyard will be cleaned up after storms prior to allowing children to use outside area. LPA observed storage area in backyard area near doghouse that is accessible to children. LPA advised licensee to make inaccessible to children.

The home was inspected inside for comfort, cleanliness, telephone service, heating, and ventilation. Medications are stored in cabinet in kitchen inaccessible to children. LPA advised licensee to place safety latch on cabinet.

The First Aid kit is in laundry room cabinet inaccessible to children. Per licensee, there are no weapons or firearms in the home. LPA did not observe any weapons or firearms. Smoke detectors are in operable condition. The home has a carbon monoxide detector that is operable. The Fire Extinguisher (10-A:2-B:C) has a green indicator. Fire extinguisher meets standards set by State Fire Marshall. The licensee's Pediatric CPR/First Aid expires on 04/09/2024. The licensee, Tammie Chism has completed the required Mandated Reporter training. LPA advised that licensee, Scott Chism must complete by POC due date. Per Licensee, Health and Safety Training was completed with First Aid/CPR Training. LPA observed completion of 30 hours of Adult and Pediatric First Aid/CPR training. LPA advised licensee to submit proof of completion of Preventative Health Practices including Lead Training. Per Licensee, Provider orientation was completed with Inyo County. LPA advised licensee that proof of completion must be submitted or proof of registration by POC due date, 3/31/23.

The required posted documents were posted and located in the childcare room: Notification of Parent's Rights Poster (PUB394), Emergency Disaster Plan (LIC610A), and Earthquake Preparedness Checklist (LIC9148).

The following was discussed with the licensee:

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kristina DiazTELEPHONE: (661) 202-3372
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TAMMIE AND SCOTT CHISM
FACILITY NUMBER: 147700006
VISIT DATE: 03/24/2023
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Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; The licensee was reminded that 100% supervision is required at all times to children in care; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

The licensee was informed that all adults living in or having access to the home, or are employees are required to have fingerprint clearances with Department of Justice, FBI, and Child Abuse Central Index prior to having contact or working with children. If the is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analysis of any person who will be visiting regularly or for longer than one week. The licensee was advised to utilize the Request for Live scan Service LIC9163 to have adults fingerprinted and associated to the home.

The licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kristina DiazTELEPHONE: (661) 202-3372
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TAMMIE AND SCOTT CHISM
FACILITY NUMBER: 147700006
VISIT DATE: 03/24/2023
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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, licensees, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Licensees must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Prior to making alterations or additions to a family childcare home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family childcare home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

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

Lead Flyer Requirement Health and Safety Code 1596.7996, mandated that effective January 1, 2019, CCC's and FCCH's are required to provide parents and guardians of children enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. A Lead Poisoning Facts Flyer was created, in partnership with the California Department of Public Health (CDPH), to satisfy this requirement.

The licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kristina DiazTELEPHONE: (661) 202-3372
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: TAMMIE AND SCOTT CHISM
FACILITY NUMBER: 147700006
VISIT DATE: 03/24/2023
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Licensee will provide proof of correction for the following by: 3/31/23 or contact LPA to request extension or explanation:

· Place safety knobs on all doors

· Place safety latches on cabinets containing medications, knives, and cleaning supplies

· Provide proof of completion of mandatory reporter training for licensee, Scott Chism

· Provide proof of TB skin tests for licensees, Tammie and Scott Chism

· Provide Control of property: deed, tax bill, mortgage statement

· Provide signed LIC 9149 and LIC 9151 – Owner notification and consent (Provided to Licensee)

· Provide signed LIC 9108 – Statement Acknowledging Requirement to Report Child Abuse

· Provide Proof of Completion of Provider Orientation or Registration

· Provide Proof of Completion of Preventative Health Practices including Lead Training

The following Type B citations were issued:

Facility Administration - Type B: 1596.8662(b)(1) - Per licensee, co-licensee, Scott Chism does not have contact with children and will be removed from license. LPA informed licensee that all licensees are required to complete mandated reporter training every two years.



Records - Type B: 1597.622(a)(1) - LPA observed licensee create statement of declination for flu vaccine; LPA informed licensee that co-licensee would need to provide proof of vaccine or submit declination statement to department.

Exit interview conducted with licensee, Tammie Chism. A copy of this report, appeal rights and notice of site visit were left with the licensee.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kristina DiazTELEPHONE: (661) 202-3372
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC809 (FAS) - (06/04)
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