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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 147700032
Report Date: 10/24/2019
Date Signed: 10/24/2019 04:58:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:KLIKS FAMILY CHILD CAREFACILITY NUMBER:
147700032
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
10/24/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Raschelle KliksTIME COMPLETED:
05:08 PM
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Licensing Program Analyst (LPA) Jacky San met with Applicant, Raschelle Kliks on 10/24/2019 or the purpose of conducting a Pre-Licensing Inspection. Applicant is requesting to provide care and supervision for a Small Family Child Care Home for the capacity of (8) children. In today visit, is the applicant, 2 daughter, Grand son, and nephew. Per applicant all adults residing in the home has an Criminal Record Clearance (DOJ/FBI and Child Abuse Index Child. Applicant and LPA toured the home indoor and outdoor to ensure the home meets licensing requirements. Applicant is requesting the days and hours of operation will be M-F, 7am-5pm.

The home is set up as follows: This is a 1 story home with 3 bedrooms and 2 bathrooms. Per Applicant the following areas of the home with be utilized for the Family Child Care: Kitchen, Front yard, Living room, bedroom 2, and bathroom#1. The off-limits of the home are the Master bedroom, bathroom#2, bedroom number 1, dining room, and backyard. There is no fireplace; however, there is Pellet stove that is currently not operable. The home does not have a central heating nor air conditioning. There are two swamp coolers. The kitchen sharp utensils are put away; however, drawers still need safety latches. Poisons and medications are put away in the master bedroom which is off-limit area. Bathrooms were toured and inspected sink/toilet are in operable condition. All unused electrical outlets are completely plugged and made inaccessible to children. Applicant have a few toys available but will accumulate more as time progress. The home needs some cleaning and organizing. Applicant indicated that she will order napping equipment. Per Applicant the children will nap on cots in the living room and bedroom #2. The outdoor play area needs to be clean, organize and free from all debris or any dangerous conditions. Backyard is fenced. There is a working Landline/cell phone; smoke detectors and carbon monoxide detector tested operable. There is a fully charged fire extinguisher (2A10BC). Fully stocked first aid kit with manual. Hot water tested at a safe temperature between 105-120 degrees. Applicant states there are no weapons in the home or on the premises. There is a hot tub with a locking led made inaccessible to children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jacky SanTELEPHONE: (661) 305-3690
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: KLIKS FAMILY CHILD CARE
FACILITY NUMBER: 147700032
VISIT DATE: 10/24/2019
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Applicant has current CPR, First Aid Training with the expiration dates of 09/21/2021 and Prevented Health and Safety Training. Applicant was advised that it was be renew every 2 year. All adults in the home have a fingerprint clearance and TB exam. Applicant has proof of being immunized against influenza, pertussis and measles. Applicant has proof of Mandated Reporting Training dated 09/12/2019. Applicant was advised that it was be renew every year. Applicant indicated that she will not be providing transportation. Per applicant meals and snack will be provided for children.

The following was discussed with the Applicant:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter. Applicant reminded that 100% supervision is required at all times to children in care. Applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Applicant was made aware that it is he/she 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 tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
·On January 1, 2018 or before March 30, 2018, a person who, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com

**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.

Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family child care homes shall post during hours of operation. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jacky SanTELEPHONE: (661) 305-3690
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: KLIKS FAMILY CHILD CARE
FACILITY NUMBER: 147700032
VISIT DATE: 10/24/2019
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§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (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

**Incidental medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. 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

Applicant advised visit www.shotsforschool.org for Immunization information.
Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

Prior to being licensed the follow is required by: November 7, 2019
  1. Safety knobs on stove
  2. Safety gates required for bedroom 1 and master bedroom
  3. The outdoor play area needs to be clean, organize and free from all debris or any dangerous conditions
  4. Kitchen corner needs to be rearranged
  5. Parents board needs to be up and have all the required document (Picture will be taken)
  6. Medication in Bathroom #1 needs to be removed
  7. Drawers needs safety latches
  8. Napping equipment
  9. Immunization (Measles, Pertussis, and Flu)
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jacky SanTELEPHONE: (661) 305-3690
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: KLIKS FAMILY CHILD CARE
FACILITY NUMBER: 147700032
VISIT DATE: 10/24/2019
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*** (Before picture were taken and after picture will be submitted)***

**Applicant was given the pre-licensing application packet with licensing forms included.

**As a result of this inspection, the home does not meet Title 22 Regulations. Corrections are required.

Exit interview conducted: A copy of this report, notice of site inspection was discussed and left with Applicant, Raschelle Kliks.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jacky SanTELEPHONE: (661) 305-3690
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4