197414219-1-22-2020-12-CC-LPHS-BL3TC6-20200122133614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414219
Report Date: 01/22/2020
Date Signed: 01/22/2020 01:36:25 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:	ROBERTS FAMILY CHILD CARE		FACILITY NUMBER:	197414219
ADMINISTRATOR:	ROBERTS, GWENDOLYN J.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 400-9912
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	14	CENSUS: 2	DATE:	01/22/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Gwendolyn Roberts		TIME COMPLETED:	01:35 PM

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On January 22, 2020 at 9:00 AM, Licensing Program Analyst (LPA) Loyce Phillips met with Licensee, Gwendolyn Roberts, who guided analyst on a tour of the home for a Required 1 year Annual Inspection. This is a two story single family home. The home has 3 bedrooms, 2 bathrooms, living room, family room, kitchen, dining room, and attached garage. There is a 125 gallon fish tank in the dining room area which is covered. Present during inspection were Licensee, licensee's two assistants and 2 child care children. Days/hours of operation 7 days a week less than 24 hours. Licensee is aware that there must be an awake staff present when children are in care.

Main care is provided in the extended family room which is designated the day care room. Children utilize the bathroom located near the front entrance. Off limit areas include the entire second floor of the home and the attached garage. The stairs are inaccessible to children by use of a gate. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation. Poisons, detergents, cleaning compounds medicines and hazardous items that can pose a danger to children are inaccessible to children.

Children play in the backyard of the home. Licensee states the backyard is currently off limits for the winter time and provided a declaration on LIC 855. There is an above ground swimming pool with child chain link fence in place. The fence is 5ft tall and has 2 gates that open away from the pool. Both gates have a pad lock on them. The home has 2 small dogs.

Per Licensee, there are no weapons or firearms on the premise. LPA did not observe any in the home. There are age appropriate toys. LPA observed blankets as equipment.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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: ROBERTS FAMILY CHILD CARE	FACILITY NUMBER: 197414219
	VISIT DATE: 01/22/2020

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The required Fire Extinguisher (2A10BC), was fully charged in the green and serviced within a year. The Smoke Detector and Carbon Monoxide Detector are in operable condition. The home has a fireplace which is covered with a metal and glass screen . The home has central AC and heat. CPR/First Aid expires 10/2020. Licensee has required immunization. Mandated Reporter training completed on 02/12/18. The First Aid kit was observed and is complete.

Facility roster was complete and maintained. Earthquake/fire drills is current. LPA reviewed 2 children files for immunization records and signed Notification of Parents' Rights form.

Requirements for fingerprint clearances and associations were discussed with the Licensee. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents.

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 the report within 7 days) and on the form LIC624B.

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 this requirement is not met, civil penalties in the amount of $100 per violation will be assessed.

The following was discussed with the Licensee:

Capacity requirements, Notification of Parent's Rights, Roster requirements (keep updated names and blue sheet), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that supervision is always required to children in care. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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: ROBERTS FAMILY CHILD CARE	FACILITY NUMBER: 197414219
	VISIT DATE: 01/22/2020

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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, seersuckers and any other items that fall into that category.

Incidental Medical Services (IMS) policy was discussed. No Incidental Medical Services are currently being provided. 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 informed to review Quarterly updates/regulations for 2015-2019 on the department website: Summer 2015 - Incidental Medical Services information.

--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and

updates/changes to the regulations.
--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Licensee was advised visit www.shotsforschool.org for Immunization information.

The On Duty Worker is available for questions Monday through Friday at (661) 789-6944 from 8:00 AM - 5:00 PM.

During records review it was noted that an employee was working in the home and was not cleared back in September of 2019.

1 Type A deficiencies were cited during this inspection. LIC 809D was given. Appeal Rights were also given to licensee.

An exit interview was conducted, and a copy of this report was read and provided to Gwendolyn Roberts.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: ROBERTS FAMILY CHILD CARE	FACILITY NUMBER: 197414219
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/22/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/31/2020 Section Cited	1 2 3 4 5 6 7	102370(d)(1) Criminal Record Clearance (d)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
	8 9 10 11 12 13 14	(1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by LPA reviewed documents proving that employee was working in the home without fingerprint clearance.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

LIC809 (FAS) - (06/04)

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