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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409552
Report Date: 10/24/2019
Date Signed: 10/24/2019 10:38:55 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:SIMMONS FAMILY CHILD CAREFACILITY NUMBER:
197409552
ADMINISTRATOR:SIMMONS, LEFLORAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 947-6375
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 4DATE:
10/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Leflora SimmonsTIME COMPLETED:
10:50 PM
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Licensing Program Analyst (LPA) Smith met with licensee, LeFlora Simmons, for the purpose a Random/Annual inspection. Family members residing in the home include 1 adult (licensee) and adult daughter (when home from college). This is a single story 3 bedroom, 2 bathroom home with kitchen, living room, laundry room, family room and garage. The garage is used for storage only and no child care activities are conducted there. There is no pool, spa or other bodies of water on the premises. Upon arrival LPA observed 4 child care children in care.

Main care is provided in the family room and bedroom #3. Children use the bathroom located in the hallway. Children have access to the living room and backyard. Off limit areas include the home's 2 bedrooms (key lock and safety knob), 1 bathroom (master bedroom), laundry (key lock) and the garage (entrance through the laundry room). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (kept in laundry area), medicines, and hazardous items that can pose a danger to children. Sharp knives and medicines are located in upper kitchen cabinet above the microwave. Facility roster is complete and maintained current. Fire/earthquake drills are also current.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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: SIMMONS FAMILY CHILD CARE
FACILITY NUMBER: 197409552
VISIT DATE: 10/24/2019
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Children play in the backyard. The right side of the yard has a gate and is locked. There is a grass and concrete area for active play. There is 1 small pet. There are no swings. LPA observed Little Tikes play equipment on the left side of the house. There is a covered patio area.

Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. LPA observed age appropriate toys and napping equipment on the premises. Cots are available for napping children. The required fire extinguisher (2A10BC), smoke detector and carbon monoxide detector are in operable condition. Fireplace (living room) is properly screened. Home has central AC and heat. CPR/First Aid expires 11/2/2019. Mandated Reporter expires 3/5/2020. First Aid kit was observed. LPA observed the parent board and required documents are posted.



The following was discussed with the licensee:
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 were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in 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.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
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)
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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: SIMMONS FAMILY CHILD CARE
FACILITY NUMBER: 197409552
VISIT DATE: 10/24/2019
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Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, PER PERSON.

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

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. 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.



The 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 BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
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)
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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: SIMMONS FAMILY CHILD CARE
FACILITY NUMBER: 197409552
VISIT DATE: 10/24/2019
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Licensee informed to review all updates/regulations on the department website. Licensee can also review the Quarterly Updates which includes information on: AB 1207 - all child care employees must complete mandated reporter training beginning January 2018; AB 1387 - process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 277 - require all children attending day care or school based programs to be immunized and will eliminate personal/religious belief exemptions; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles.

The licensee was informed of the role and responsibilities of being a mandated reporter, renewal required every 2 years for a licensed child care provider, administrator, or employee ( www.mandatereporterca.com )

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-

Guide-to-Safe-Sleep.aspx

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Safe Sleep and recent recall material provided to licensee.



An exit interview was conducted and a copy of this report was provided to the licensee on this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
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)
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