197415591-10-10-2019-12-CC-VHUT-BGTQKJ-20191010121426

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415591
Report Date: 10/10/2019
Date Signed: 10/10/2019 12:14:38 PM

COMPREHENSIVE INSPECTION

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:	POWELL FAMILY CHILD CARE		FACILITY NUMBER:	197415591
ADMINISTRATOR:	POWELL, ANTOINETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 802-6841
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 12	DATE:	10/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Antoinette Powell		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Victoria Hunt met with licensee, Antoinette Powell, who guided analyst on a tour of the facility for a annual random inspection. During the time of this inspection licensee had a total of twelve children in care. Upon initial arrival three children were observed to be playing in the playroom and nine children observed to be playing outside in the backyard. Residing in the home includes: adult (licensee), and her minor child. 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. This facility operates from 6:00 am- 6:00 pm, Monday thru Friday. Licensee's assistant was present during the during the time of this inspection. This family child care facility is a two story home with 5 bedroom, 4 bathroom home with kitchen, dining room, living room, formal dining room, laundry room, family room, and a converted garage with permits which is currently being used as a playroom. Main care is conducted in the, living room, formal dining room, and converted room, which are the designated playrooms. In playroom #1 LPA observed toys along with (2) infant cribs, a small climbing apparatus used for climbing, a small play house and other various in which the children can use or play with. Toys and furniture were observed to be in good condition. In room #2 there are are cubbies in which children can store their belongs, the cubby was observed to have each child's name labeled on it. In playroom #3 there were several cabinets observed to have games, books and toys stored on the shelves. There is educational/learning material posted on the walls.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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: POWELL FAMILY CHILD CARE	FACILITY NUMBER: 197415591
	VISIT DATE: 10/10/2019

NARRATIVE

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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, sink, and an ample supply of towels and soap accessible for the children to use. The bathroom is clean, sanitized and in good repair.

All cleaning compounds/detergents were stored so that they are inaccessible to children. Children do not have access to the kitchen. Napping equipment observed to be on the premises in good and sanitary condition.

Child have access to the backyard area. The backyard is grass/concrete landscaping. The backyard is completely surrounded by brick fencing . The backyard has a vinyl fence that separates part of the backyard. The fence was observed to be locked and the children are unable to access the secured area. Several toys were observed to be in the backyard area in which children have access to play. All toys were in good condition and repair. There is a small gazebo that is used for shade for the children.

LPA reviewed children records, records were complete. All required licensing document were posted and observe to be located in the hallway near the playroom. 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.

This facility has a fire extinguisher 2A10BC meets fire marshal standards and was operational during visit. The home has a working telephone service available. Per licensee, disaster/fire drills are conducted at least once a month. LPA observed disaster/fire drill log as current.

This home was clean, orderly and comfortable for children in care. This facility has a first aid kit on premises. LPA observed that licensee has a valid Pediatric CPR and First Aid card that expires on 10/2017. A copy of the of the Pediatric CPR and First Aid was obtained for the file. This facility has a current roster. Licensee and her assistant has completed mandated reporter training and has the required immunization for pertussis and measles.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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: POWELL FAMILY CHILD CARE	FACILITY NUMBER: 197415591
	VISIT DATE: 10/10/2019

NARRATIVE

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Per licensee there are no weapons or firearms on the premise. There are no pools or bodies of water on premies at this facility.

Areas off limit include: all bedrooms upstairs and downstair, and the kitchen.

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 18^th 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 Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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: POWELL FAMILY CHILD CARE	FACILITY NUMBER: 197415591
	VISIT DATE: 10/10/2019

NARRATIVE

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**Licensee informed to review updates/regulations for 2016/2017 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 provided with quarterly update for Fall 2019 during the time of this inspection licensee is already set up to receive updates.

This facility was in compliance with Title 22 Regulations. No citations were issued during this inspection. A copy of this report was read and discussed with licensee. Notice of Site Visit left at the facility.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

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