197493414-8-9-2019-30-CC-JCHR-BEVQJF-20190809121240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493414
Report Date: 08/09/2019
Date Signed: 08/09/2019 12:13:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	DEJAN FAMILY CHILD CARE		FACILITY NUMBER:	197493414
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	08/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:27 AM
MET WITH:	licensee		TIME COMPLETED:	12:23 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	On 8/9/2019 Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced Annual Random visit for the DeJan family day care home. All persons present has received a criminal background clearance and are associated to the home.The home was inspected inside and out for health and safety compliance per Title 22. LPA observed the following: Care and supervision were observed The homes capacity was within the scope of the license Ratio standards were met; there were 3 infants and two preschoolers with licensee and one assistant. Appropriate size fire extinguisher carbon and smoke detector present & operable. Detergents, and knives were inaccessible, Toxins were locked and inaccessible. No guns or weapons present as stated by the Licensee, no weapons observed by LPA. Properly working telephone License, facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights Poster and California Safety Seat Law were not posted At least one person present was current in Pediatric CPR/First Aid The home has a under ground pool in the rear of the home.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DEJAN FAMILY CHILD CARE	FACILITY NUMBER: 197493414
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/09/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/09/2019 Section Cited HSC 1597.622	1 2 3 4 5 6 7	(2) If a person meets all other requirements for employment or volunteering, as applicable, but needs additional time to obtain and provide his or her immunization records, the person may be employed or volunteer conditionally for a maximum of 30 days	1 2 3 4 5 6 7	Licensee shall provide immunization records no later than 9/30/2019 to the department by fax or mail.
	8 9 10 11 12 13 14	upon signing and submitting a written statement attesting that he or she has been immunized as required. This standard was not met as evidence by: immunization records for assistant Kyrah Sutherland were not avaible for review. This is a possible risk to children in care. A type B citation was issued.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DEJAN FAMILY CHILD CARE	FACILITY NUMBER: 197493414
	VISIT DATE: 08/09/2019

NARRATIVE

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The pool is gated with an self closing, self latching gate and a secure cover.
Children records available and in good order.
Toys, equipment and materials available and in good order
The homes fire place was gated and inaccessible to children in care
Children use the front yard for out doors play. The yard is completely gated.

CAPACITY INCREASE
The home has a fire clearance for 14 children, Day care activities shall be conducted in the living room and dining room. The facility sketch was updated to include the den area for day care. The home has 1 assistant. All adults requiring a criminal background check are cleared and associated to the home.

For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
Twelve children, no more than four of whom may be infants; or
More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
Health and Safety Code section 1597.465 states:
A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met:
At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.
No more than three infants are cared for during any time when more than 12 children are being cared for.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DEJAN FAMILY CHILD CARE	FACILITY NUMBER: 197493414
	VISIT DATE: 08/09/2019

NARRATIVE

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The licensee notifies a parent that the facility is caring for two additional school-age children and that there may be up to 13 or 14 children in the home at one time. Parents shall complete LIC. 9150.
The licensee obtains the written consent of the property owner when the family day care home is operated on property that is leased or rented. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.

· Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.
· .Applicant was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and to never shake a baby to prevent the Shaken Baby Syndrome.
· Applicant was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.
· The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents.

Also, discussed was; Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. Exemption were also discussed

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DEJAN FAMILY CHILD CARE	FACILITY NUMBER: 197493414
	VISIT DATE: 08/09/2019

NARRATIVE

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· Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541; Email Address: childcareadvocatesprogram@dss.ca.gov
· Beginning on January 1, 2018, AB 1207, 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. Volunteers are encouraged but not required to take the training. 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

AB 2370 Lead Bill Flyer was discussed and provided to the licensee.

Based on a file review the home has been in substantial compliance.
Following todays inspection the home shall be granted an increase in capacity.
A copy of this report was discussed and provided to the licensee.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2019

LIC809 (FAS) - (06/04)

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