197419281-10-7-2019-12-CC-IORA-BGQT2D-20191007142034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419281
Report Date: 10/07/2019
Date Signed: 10/07/2019 02:20:44 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:	CARVER FAMILY CHILD CARE		FACILITY NUMBER:	197419281
ADMINISTRATOR:	CARVER, STARR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 339-3867
CITY:	SAN FERNANDO	STATE: CA	ZIP CODE:	91340
CAPACITY:	14	CENSUS: 7	DATE:	10/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Starr Carver		TIME COMPLETED:	02:29 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) Isabel Ortega conducted an unannounced annual random inspection. The LPA met with licensee Starr Carver who guided the LPA on a tour of the facility. Also present today is Licensee’s two Assistants (fingerprint cleared). Upon entry to the facility the LPA observed 7 child under care. This is a one story single-family home. There is a children's playroom, living room, kitchen, dining room, five bedrooms and two restrooms. Main care is provided in the children's playroom. The children use the bathroom located to the left of the day care entrance door. The off-limits areas are the three bedrooms, kitchen, dining room, living room and second bathroom. The day care home provides breakfast, morning snack, lunch, afternoon snack, and dinner as needed. The operating child care hours vary depending on the children's family need. Children eat near the playroom. According to Licensee she provides transportation. Licensee demonstrated a valid CA Driver's license and Proof of valid insurance. 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, all cleaning chemicals and medications are kept in the off limits kitchen area. 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.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

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: CARVER FAMILY CHILD CARE	FACILITY NUMBER: 197419281
	VISIT DATE: 10/07/2019

NARRATIVE

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The First Aid kit was observed and is complete. The required fire extinguisher (2A10BC) is in reading in green. Smoke and carbon monoxide detectors are in operable condition (tested 1:00 P.M.). Fire and disaster drills are conducted every six months and logged last emergency drill was logged by Licensee on 6/14/19. Pediatric CPR and First Aid certificate expires on 6/11/2021.

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 provided proof of immunization against pertussis (TDAP), measles (MMR), and influenza (declaration).

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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, baby bouncers, 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.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

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: CARVER FAMILY CHILD CARE	FACILITY NUMBER: 197419281
	VISIT DATE: 10/07/2019

NARRATIVE

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Safe Sleep new regulations coming soon discussed with Licensee and new immunization regulations effective July 1, 2019 were discussed. Copy of new immunization form provided.

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.

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 10/07/2019. 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 Starr Carver.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

LIC809 (FAS) - (06/04)

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