197419318-10-11-2019-12-CC-LKIG-BGUMYK-20191011100139

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419318
Report Date: 10/11/2019
Date Signed: 10/11/2019 10:01:51 AM

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:	MCCORVEY FAMILY CHILD CARE		FACILITY NUMBER:	197419318
ADMINISTRATOR:	SHEILA MCCORVEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 941-4357
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	14	CENSUS: 4	DATE:	10/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Sheila McCorvey		TIME COMPLETED:	10:00 AM

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) Lady King-Lewis conducted an Annual Random inspection at the above facility. Upon arrival LPA was greeted by licensee, Shelia McCorvey. Licensee hours of operation are 7 day a week, less than 24 hours. Licensee is aware awake supervision is require when operating a license daycare. LPA observed 4 children and 0 infants. A copy of Child Care Facility Roster was emailed to LPA. LPA observed all 5 children files contained children immunization records and signed copy of Notification of Parents Rights. Per Licensing Information System (LIS) all adults residing and working in the home have obtained background clearances. Per LIS, facility annual fees are current. The licensee is operating within proper capacity and ratios. LPA observed licensee to be present at the home and providing adequate care and supervision. The home is clean, orderly, comfortable and well ventilated. Licensee's poisons, detergent, cleaning compounds, medications and other items which could pose a danger to child are stored where they are inaccessible to children.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

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: MCCORVEY FAMILY CHILD CARE	FACILITY NUMBER: 197419318
	VISIT DATE: 10/11/2019

NARRATIVE

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LPA observed working smoke detector and Carbon Monoxide, fully charged 2A10BC fire extinguisher and working telephone.

There are several age appropriate toys and a first aid kit on the premises.

The day care takes place in living room, family room, dinning area, hallway bathroom, bedroom 1/ infant room, bedroom 2/ office and rear yard. The backyard is completely fenced in. There are no bodies of water in the FCCH.

Per the licensee, there are no firearms on the premises.

The licensee has current CPR and first aid that expires, 02-17-21.
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The licensee has taken the mandated reporter training.

The licensee has the required immunization's.

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

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

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: MCCORVEY FAMILY CHILD CARE	FACILITY NUMBER: 197419318
	VISIT DATE: 10/11/2019

NARRATIVE

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The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507

Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Per the licensee, fire and disaster drills are conducted monthly; last drill documented and conducted on 09-01-19.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610A), Notification of Parents' Rights Poster (PUB 394).

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: MCCORVEY FAMILY CHILD CARE	FACILITY NUMBER: 197419318
	VISIT DATE: 10/11/2019

NARRATIVE

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The following was discussed with the licensee:
LPA encouraged licensee to review the attached web site and follow safe sleep best practices:
• Always place infants on their backs for sleeping
• Use only a tight-fitting sheet on the crib or play yard mattress
• Do not hang any items from the crib or above the crib
• Keep all items, including blankets, out of the crib or play yard
• Pacifiers may be used as long as they do not have items attached to them
• Infants should not be swaddled or have any items covering them while sleeping
• The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake safety and necessity of drills (every 6 months), required forms for children’s files, facility files, posting requirements, penalty, fingerprint clearance, and the transfer process and penalty. For additional information and forms visit our website at: www.ccld.ca.gov

Licensee is aware of CCLD child care videos on Community Care Licensing website at: https://ccld.childcarevideos.org/

No deficiencies cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: MCCORVEY FAMILY CHILD CARE	FACILITY NUMBER: 197419318
	VISIT DATE: 10/11/2019

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 26 27 28 29 30 31 32	An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided to the licensee.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

LIC809 (FAS) - (06/04)

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