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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408749
Report Date: 06/09/2022
Date Signed: 06/09/2022 01:42:43 PM


Document Has Been Signed on 06/09/2022 01:42 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



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: 1DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Carolina MathisonTIME COMPLETED:
01:57 PM
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Carolina Mathison, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a one story 3 bedroom, 2 bathroom home with kitchen, dining room, living room, and detached garage. There is no pool on the premises. Upon arrival LPA observed 1 child with the licensee.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway near the homes bedrooms. Children have access to the living room (main care area), dining room (classroom) children's bathroom and backyard. Off limit areas include the homes bedrooms, 1 bathroom, kitchen, and detached garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked in laundry area), medicines (in master bedroom) and hazardous items (sharp knives inaccessible on top of kitchen cabinet) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/play equipment were observed on the premises. There is a designated area for ill children as necessary in the office/guest bedroom. Per licensee, there are firearms present at this facility. Fire arms were observed to be locked and ammunition was separate from the firearm.

The last fire/earthquake drill was completed 03/01/22. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
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: MATHISON FAMILY CHILD CARE
FACILITY NUMBER: 197408749
VISIT DATE: 06/09/2022
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Kitchen: Per licensee the kitchen is off-limits. Children only pass through kitchen to go to the outdoor area. Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack and dinner. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are locked in the laundry area. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. LPA observed the play structure to be in good condition. The play structure has sand under it to provide cushioning. The backyard also has an off limits area that surrounds the children's outdoor area. The off limits area is made inaccessible by a fence. LPA observed the toys in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 08/2023. Mandated Reporter was completed 06/30/21. Children nap on mats in the living room.

Documents discussed: Safe Sleep PIN 20-24-CCP, LIC 9227, LIC 311D, and Infant Sleep Log.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Carolina Mathison.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
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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