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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417757
Report Date: 08/11/2022
Date Signed: 08/11/2022 03:12:02 PM


Document Has Been Signed on 08/11/2022 03:12 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:KELLY FAMILY CHILD CAREFACILITY NUMBER:
197417757
ADMINISTRATOR:KELLY,BARBARA & LEOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 940-3366
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 9DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Barbara Kelly, Licensee TIME COMPLETED:
03:20 PM
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On 08/11/22 Licensing Program Analysts (LPAs) Justeene Tamayo and Barbara Beneroso met with Licensee, Barbara Kelly, who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 4 bedroom, 3 bathroom home with kitchen/dining, family room, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival, LPAs observed 7 preschool children and 2 infants in care, along with two assistants and the licensee. Family members residing in the home include 2 adults (licensee and licensee's husband) and two child. Facility operation are Monday-Friday 6:30AM-5:30PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room and dining area. Children use the bathroom in hallway on the left. Children have access to the living room and dining room area. Off limit areas include all bedrooms, bathrooms #2 and #3 (upstairs), laundry room (with key lock), and garage (has a key lock door knob). The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (in laundry room with key lock and under kitchen sink with safety latch), medicines (master bedroom upstairs in off limit area ) and hazardous items (sharp knives in upper kitchen pantry unreachable to children in care) that can pose a danger to children. LPAs did not observe a fireplace in the home. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, 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 family room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (landline and cell).
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 08/11/2022
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Fire/earthquake drills are complete and maintained current. Last fire/disaster drill was completed on 07/21/2022.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPAs did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable. LPAs observed a diaper changing station next to the child care bathroom.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the laundry room(off limit) and under kitchen sink with a safety latch. Breakfast, lunch, snacks and dinner are provided. Licensee currently has a food program. Naps are provided on cots in the living room area.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). There is no body of water. There are two outdoor air conditioner inaccessible to children with barricaded gate around them. LPAs observed age appropriate toys and the barbecue pit covered. LPAs observed one dog on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 03/26/2023. Mandated Reporter expired on 02/03/2020. Licensee will retake the mandated reporter training at www.mandatedreporterca.com and send proof of completion to LPA Tamayo no later than today 08/11/22. There are no window cords accessible to children.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
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: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 08/11/2022
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Documents Provided and or Discussed: Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227) and Emergency Disaster Plan. Licensee stated currently has child care insurance.

Licensee Kelly 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.

LPAs discussed the safe sleep regulations with licensee Kirnon 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. LPAs 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 to licensee 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 Barbara Kelly along with her appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
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