191228064-5-21-2019-12-CC-TLAN-BCDUU5-20190521155300

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191228064
Report Date: 05/21/2019
Date Signed: 05/21/2019 03:54:53 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:	DAVIDSON FAMILY DAY CARE		FACILITY NUMBER:	191228064
ADMINISTRATOR:	DAVIDSON, SHERRI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 251-3695
CITY:	CANYON COUNTRY	STATE: CA	ZIP CODE:	91351
CAPACITY:	14	CENSUS: 3	DATE:	05/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Sherri Davidson		TIME COMPLETED:	04:07 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	Licensing Program Analyst (LPA) Lawson met with Licensee, Sherri Davidson, who guided analyst on a tour of the facility for an Random/Annual Inspection. This is a two story 4 bedroom, 3 bathroom home with Kitchen/Dining area, Living room, Den, Garage and Backyard. There is no pool/spa or body of water on the premises. Present during inspection was Licensee(s), her Adult Daughter and 3 children. Facility runs two class Monday-Thursday from 10:30 AM to 2:30 PM, and before and after care as needed. Incidental Medical Services (IMS) policy was discussed. Main care is provided Den and Living Room. Children use the Bathroom located in the hall. Off limit areas include all of upstairs (Bedrooms and Bathroom #2 and #3), garage and kitchen. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating (central) and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. Backyard is completely fenced. One dog.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee Lawson	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: DAVIDSON FAMILY DAY CARE	FACILITY NUMBER: 191228064
	VISIT DATE: 05/21/2019

NARRATIVE

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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.html

--Licensee was advised visit www.shotsforschool.org for Immunization information.

--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724
--Family Child Care Providers (Disaster Planning information): https://ccld.family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Videos: https://ccld.childcarevideos.org
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
--Mandatedreporterca.com

The On Duty Worker is available for questions at (661) 789-6944 Monday through Friday 8am-5pm.

No deficiencies cited. LPA provided consultation during inspection.

An exit interview was conducted and a copy of this report was read and provided to Licensee Sona Hovespyan.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee Lawson	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: DAVIDSON FAMILY DAY CARE	FACILITY NUMBER: 191228064
	VISIT DATE: 05/21/2019

NARRATIVE

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Per Licensee, there are no weapons or firearms on the premise. LPA did not observe any in the home. There are age appropriate toys. The required fire extinguisher (2A10BC) and smoke detector are in operable condition. The home has a Carbon Monoxide detector. Home has central AC and heat. CPR/First Aid expire 06/2019. The First Aid kit was observed and is complete.

Requirements for fingerprint clearances and associations were discussed with the Licensee.

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 (call within 24 hours and submit form in 7 days) and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee Lawson	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

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