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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412230
Report Date: 09/25/2019
Date Signed: 09/25/2019 12:30:52 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:MAYER FAMILY CHILD CAREFACILITY NUMBER:
197412230
ADMINISTRATOR:MAYER, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 285-5077
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 7DATE:
09/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Michelle MayerTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced annual random inspection. The LPA met with licensee Michelle Mayer who guided the LPA on a tour of the facility at 10:50 a.m. Upon entry to the facility the LPA observed seven child under care.

This is a one story single-family home with an attached garage. There is a children's playroom, living room, kitchen, dining room, three bedrooms and two restrooms. Main care is provided in the children's playroom. The children use the bathroom located to the left of the children's playroom. The off-limits areas are all three bedrooms, kitchen, second bathroom and the attached garage.

The day care home provides breakfast, lunch, afternoon snack, and dinner as needed. The operating child care hours are Monday - Friday: varied schedule depending on the children's need.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The knives are kept in the kitchen on top of the refrigerator. Cleaning chemicals are stored underneath the sink (child safety latch observed). Medication in the second bathroom in the off limits area inaccessible to children.

There are age appropriate toys and equipment on the premises. Per the licensee there are no weapons or firearms of any kind in the facility. The LPA did not observe any weapons.

The First Aid kit was observed and is complete. The required fire extinguisher (2A10BC) receipt purchased dated 9/25/19. Smoke and carbon monoxide detectors are in operable condition (tested 10:55 A.M.). Fire and disaster drills are conducted every six months and logged last emergency drill was conducted August 5, 2019 at 11:00 a.m.. Pediatric CPR and First Aid certificate expires on 11/01/2019. Facility fees are current according to LIS.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
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: MAYER FAMILY CHILD CARE
FACILITY NUMBER: 197412230
VISIT DATE: 09/25/2019
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Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148)

The licensee and Assistant provided proof of immunization against pertussis (TDAP), measles (MMR), and influenza.



The LPA observed a current child roster. Child files were found to be complete.

The outdoor play area was inspected and was observed to be free of hazards, loose and sharp parts.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements and penalty.

The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analysis of any person who will be visiting regularly or for longer than #1 week.

The applicant was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

Safe Sleep new regulations coming soon discussed with Licensee and provided a handout with image of safe sleep.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MAYER FAMILY CHILD CARE
FACILITY NUMBER: 197412230
VISIT DATE: 09/25/2019
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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. Licensee demonstrated mandated Reporter certificate dated 3/01/19.

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

Child Care Advocates:


To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

The facility was in compliance per Title 22 regulations, a no deficiencies will be cited today 9/25/2019. An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided to the licensee. Appeal rights were provided and discussed with licensee Michelle Mayer.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
LIC809 (FAS) - (06/04)
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