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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408749
Report Date: 05/20/2019
Date Signed: 05/20/2019 11:35:30 AM

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:MATHISON FAMILY CHILD CAREFACILITY NUMBER:
197408749
ADMINISTRATOR:MATHISON, CAROLINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 724-1286
CITY:LAKE ELIZABETHSTATE: CAZIP CODE:
93532
CAPACITY:14CENSUS: 12DATE:
05/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Carolina MathisonTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Victoria Hunt met with Carolina Mathison licensee, who guided analyst on a tour of the facility for an annual random inspection. During the time of this inspection licensee had children twelve in care. During this initial inspection children were observed in the playroom actively working on art projects. Residing in the home includes: adult (licensee), her spouse and adult daughter. Per LIS, facility annual fees are current. All adults have been background cleared. Licensee was operating facility within ratio during the time of inspection. Licensee was observed providing adequate supervision during the inspection. Assistant was observed to be present during this inspection. This facility operates from 8:00 am-11:30am Mon-Fri.

This family child care facility is a single home 3 bedrooms, 2 bathrooms with kitchen, living room, dining room, patio, and attached garage. The attached garage was locked. The garage is used for storage only, the garage is off limits to children.



Main care is conducted in the, living room, dining room, and back yard areas.
In the living room, a fireplace was observed in the room that is properly screened and inaccessible to children. In this room, cubbies were observed in which children can store their belongings. Age appropriate toys were observed in which the children can play with at the facility.
Age appropriate furniture is on premises at the facility. The furniture is in good repair and condition. There is learning/educational material posted on the walls of the facility. LPA observed books, games, and plenty of play toys in which the children can play with on the premises.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019
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: MATHISON FAMILY CHILD CARE
FACILITY NUMBER: 197408749
VISIT DATE: 05/20/2019
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 During this inspection LPA inspected the kitchen to ensure hazardous and dangerous items were inaccessible to children. LPA observed in the kitchen area that, licensee keeps knives and sharp objects in upper cabinet next to the laundry room. Cabinets have child proof latches. Sharp objects and knives are inaccessible to children. All cabinets in the kitchen area have child proof latches.

Children utilize a bathroom that located in the hallway. The bathroom was observed to be free and clear of hazardous items. The bathroom was observed to have working toilet, pedestal sink, and an ample supply of towels and soap accessible for the children to use. The bathroom was in good and sanitary condition.

There is a laundry room/closet located near the kitchen area. Cleaning compounds/detergents were observed to be stored in the room. The laundry room/closet was observed to be locked with chain link latch on top of the closet. All cleaning items were made inaccessible to children.

Napping equipment observed to be on the premises that was in good condition.

The backyard is completely surrounded by wood fencing at least 5 ft high. LPA observed that there is a dog on premises the dog was secured by gate. LPA observed several toys in the back yard area in which children have access to. There was a large play structure with a slide in the backyard. The play apparatus was securely anchored to the ground. LPA observed sand underneath the play apparatus that was free and clear of debris or hazards. There was enough sand observed underneath the play apparatus to absorb the fall of a child if he/she would to fall. There is a shed on the backyard that was observed to be locked. There are no pools or bodies of water on premises at this facility. There are weapons on premises, weapons are locked in a safe and ammunition is kept separate from the firearm. Weapons/firearms are inaccessible to children.

LPA reviewed children records, records were complete. Immunizations for pertussis, measles, and influenza were observed for the licensee and her assistant.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019
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: MATHISON FAMILY CHILD CARE
FACILITY NUMBER: 197408749
VISIT DATE: 05/20/2019
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 All required licensing document were posted near the main entrance. All electrical outlets were properly covered. The home is clean, orderly, comfortable and well ventilated. LPA observed a working smoke detector and carbon monoxide in operational condition. The fire extinguisher 3A40BC meets fire marshal standards and was operational during visit. The home has a working telephone service available. Per licensee, disaster/fire drills are conducted every six months. LPA observed disaster/fire drill log as current. Licensee's Pediatric CPR and First Aid is valid until 08/20/19. Licensee's assistant Deena Benz Pediatric CPR and First Aid is valid until 08/20/19. Licensee and her assistant have completed the Mandated Reporter Training Certification.

Area off-limit areas include: all bedrooms.

Licensee is not providing any medical services to children. 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

The following was discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the home. Individuals within one month of their 18th birthday must be fingerprinted immediately or at least within 30 days or less of turning 18.

There shall be no smoking, no infant walkers, johnny jumpers, exersaucers and any other item that falls into that category. Also discussed were earthquake, fire & disaster drills shall be documented at least once every six months. Posting requirements were discussed such as the posting of the Parent’s Rights poster in a visible location for the children’s authorized representatives. Children records requirements, mandated child abuse and injury/ death reporting, background check clearance transfer requirements, SIDS, Infants Safe Sleep on Back, and Never Shake A Baby were all discussed. Licensee agrees children shall be positioned for sleep on their back.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019
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: MATHISON FAMILY CHILD CARE
FACILITY NUMBER: 197408749
VISIT DATE: 05/20/2019
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**Licensee informed to review updates/regulations for 2016/2017/2018 on the department website: www.ccld.ca.gov ; AB 1207 - all child care employees must complete mandated reporter training beginning January 1, 2018; AB 1387 - and AB 2236 process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles, and TB clearance, beginning September 1, 2016; AB 2231 Effective July 1, 2017 - Civil Penalty Amount changes. Licensee was advised of proposed safe sleep regulations and advise to refer to website: to https://www.nichq.org/resource

This facility was evaluated in accordance to licensing laws and regulations to ensure the health and safety of children. No deficiencies were cited today. This facility was operating in substantial compliance.

LIC 9213- Notice of Site Visit was posted and visit report was issued during today’s visit. Notice of Site Visit must remain posted for 30 consecutive days. Failure to do so will result in an immediate civil penalty assessment of $100.

An exit interview was conducted and a copy of this report was read and discussed with licensee.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019
LIC809 (FAS) - (06/04)
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