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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419281
Report Date: 06/20/2022
Date Signed: 06/20/2022 02:12:52 PM


Document Has Been Signed on 06/20/2022 02:12 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:CARVER FAMILY CHILD CAREFACILITY NUMBER:
197419281
ADMINISTRATOR:CARVER, STARRFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 339-3867
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY:14CENSUS: 12DATE:
06/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Starr Carver, LicenseeTIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee, Starr Carver, who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 4 bedroom, 2 bathroom home with kitchen/dining, family room, living room, and laundry room . There is no pool/spa or body of water on the premises. Upon arrival LPA observed 12 children in care, licensee, and licensee's assistant. LPA did not observe infants in care while conducting the inspection. Per licensee, she just enrolled one infant about two weeks ago. Family members residing in the home include 2 adults (licensee and licensee's husband) and their three children. Facility operation are Monday-Friday 7:30AM-5:30 PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the children's playroom (Permit posted and observed by LPA). The children use the bathroom located to the left of the day care entrance door. The off-limits areas are the four bedrooms, kitchen, dining room, living room, second bathroom, and backyard. All off limit areas are inaccessible with key door lock leading to the rest of the home. Children have access to the playroom, office area, bathroom #1 and day care play area on the side of the home. Off limit areas include all bedrooms, bathroom #2 and laundry room with key lock. There is currently not a garage present on the premises. 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 (laundry room inaccessible to children), medicines (off limit bathroom) and hazardous items (sharp knives in butcher block in the kitchen inaccessible with door lock leading to the kitchen) that can pose a danger to children. Fireplace is also off limits in the living room by the front door. There are safe and age appropriate toys, play equipment and materials.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2022
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: CARVER FAMILY CHILD CARE
FACILITY NUMBER: 197419281
VISIT DATE: 06/20/2022
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Upon observation, the smoke detector was not in operable condition. LPA observed licensee put new batteries in the smoke detector and also inputted a new smoke detector in operable condition. Facility has been cited a Type B Citation. Please see LIC 809-D.

The carbon monoxide detector and 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 office area by the children's playroom. Per Licensee there are no weapon/firearms in the home. Facility sketch is complete and current. There is working telephone (cell).

Fire/earthquake drills complete and maintained current. Last fire/earthquake drill was completed on 03/18/22. Roster complete and maintained current. There are age appropriate napping mat equipment in the children's playroom. Children nap on mats in the children's playroom

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

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 laundry area (off limit). Per licensee, kitchen area, and the rest of the home areas are off limits and secured with key lock leading to the rest of the home. Lunch and snacks are provided. Per licensee, the children eat breakfast at their personal homes before attending the day care. Parents pick up the children before dinner time.

Outdoor: The play area is safe for children. The play yard is completely fenced (with block cement). LPA observed the front gate to be locked at all times and Ring is also set up on the back gate. There is no body of water. LPA observed age appropriate toys. Per licensee, she currently has two dogs on the other side of the home. LPA observed appropriate toys outside.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
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: CARVER FAMILY CHILD CARE
FACILITY NUMBER: 197419281
VISIT DATE: 06/20/2022
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Advisory/Other: First Aid kit was observed with supplies readily available in the children's bathroom. CPR/First Aid expire 03/01/2024. Licensee's mandated reporter training expired. Per licensee, she will renew her mandated reporter training and email a copy of the certificate to LPA Tamayo for proof of completion. There are no window cords accessible to children.

Documents Provided and or Discussed: Mandated Reporter Training and Safe Sleep PIN 20-24-CCP. Licensee states she currently has child care insurance.

Licensee Carver 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.

LPA's discussed the safe sleep regulations with licensee Carver 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. LPA 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 Starr Carver, 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: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/20/2022 02:12 PM - It Cannot Be Edited

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: CARVER FAMILY CHILD CARE
FACILITY NUMBER: 197419281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. LPA observed the smoke detector to not be in operable condition during inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/20/2022
Plan of Correction
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Licensee put new batteries in the smoke detector. LPA observed the beeping sound once the new batteries were inputted into the smoke detector. The first smoke detector was having technical difficulties. LPA observed licensee put a new smoke detector that is in operable condition next to the old one.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2022
LIC809 (FAS) - (06/04)
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