147700014-6-9-2022-12-CC-SMOA-CF8PLM-20220609112457

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 147700014
Report Date: 06/08/2022
Date Signed: 06/09/2022 11:25:09 AM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/09/2022 11:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	M&MDaycare		FACILITY NUMBER:	147700014
ADMINISTRATOR:	Marisol Macias		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 876-1955
CITY:	Lone Pine	STATE: CA	ZIP CODE:	93545
CAPACITY:	14	CENSUS: 1	DATE:	06/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Marisol Macias Licensee		TIME COMPLETED:	03:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On June 8, 2022 at approximately 1:00 pm. Licensing Program Analyst (LPA) Steven Montoya conducted a Random Annual inspection at M & M Large Family Child Care home. LPA met with Licensee Marisol Macias. Due to LPA computer malfunction, LPA was unable to complete digital inspection report, however inspection was conducted and written inspection report was completed. Teacher/child ratios were observed. LPA observed 1 day care child and 4 of her own children present during this inspection. The FCCH hours of operations are Monday through Friday: 8:00 am to 4:30 pm. During this inspection LPA was given tour of the home by the licensee. Home is described as a 4 bed/ 2 bath modular home. LPA observed equipment/supplies, and reviewed a sample of children and staff files. Furniture and equipment were inspected for age appropriateness and good repair. All rooms observed to be clean and safe. Telephone service was verified Cell (760) 614-1143. Heating, lighting, and ventilation are adequate. There are cubbies with children's names on them for their belongings. LPA observed age appropriate toys and materials. Drinking water is available inside the home in the form of water pitchers and disposable cups. LPA observed a sufficient quantity of mats available for napping children. The bedding is stored separately. LPA observed a Fire extinguisher, smoke detectors and carbon monoxide detector were observed to be operable condition. LPA observed outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. The area was observed to be free of debris. There is an area for shade and rest. There are no open bodies of water on the premises.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: M&MDaycare	FACILITY NUMBER: 147700014
	VISIT DATE: 06/08/2022

NARRATIVE

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LPA inspected and observed the 1 bathrooms to be clean, functioning properly and age appropriate. LPA observed them all to be clean with soap, toilet paper and paper towels readily available in each. There is a kitchen with refrigerator, microwave, and sink. Licensee reports she provide lunch and snacks.

The following information was discussed with the licensee:

ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.

ü Licensee was advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B

ü Licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the Palmdale CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

Fire/earthquake drills are current. Staff was reminded to review the Licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes and the Quarterly Updates.

Continued

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: M&MDaycare	FACILITY NUMBER: 147700014
	VISIT DATE: 06/08/2022

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CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration dates; 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.

· Immunization: Licensee has the required immunization. The licensee provided a written statement declining the influenza vaccination.

· Mandated Reporter Training: Licensee was reminded to maintain completed the online mandated reporter training at www.mandatedreporterca.com for all staff.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

No deficiencies cited.

Exit interview conducted, written report was read and a copy provided to the licensee Marisol Macias. Licensee provided email address: lunefrn@gmails.com for computerized report, appeal rights and notice of site visit to be send via email.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC809 (FAS) - (06/04)

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