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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700027
Report Date: 03/15/2022
Date Signed: 03/21/2022 04:41:13 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/21/2022 04:41 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:COOPER-WARREN FAMILY CHILD CAREFACILITY NUMBER:
197700027
ADMINISTRATOR:COOPER-WARREN, MONIQUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 718-9980
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: 0DATE:
03/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Monique Copperwarren TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) King-Lewis conducted a required 1 year Inspection with licensee who guided analyst on a tour of the license day-care Licensee is also a license Resource Parent. The day care take place in the following area of the home: living room, hallway bathroom and rear yard. Licensee states she is currently house sitting two large dog in rear yard. Licensee states the day care hours of operation is 6:30 AM to 6:00 PM Monday thru Friday. Currently living in the home is licensee, licensee's spouse, minor daughter (17 years of age) and one foster placement (10 years of age male).

Physical Plant:

There are no body of water on the premises. Licensee has fire arms which are stored properly locked up in off-limits area of home. Storage areas for poisons are kept in off-limit area of home in licensee bedroom. Kitchen cabinet under kitchen sink is inaccessible to children secured with a kiddy lock. Medication are stored in licensee bedroom in off-limit area of the home, a kiddy gate secured the


off-limits area. Detergents, cleaning compounds and other items which could pose
a danger to children are inaccessible to children stored in the off limit of home(garage). LPA observed glass screen fireplace inaccessible to children. Fire extinguishers, smoke detectors, and carbon monoxide were operable dunng inspection. LPA observed
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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: COOPER-WARREN FAMILY CHILD CARE
FACILITY NUMBER: 197700027
VISIT DATE: 03/15/2022
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the home to have, central air and heating available. There is a land line telephone and a cell phone available for the license day care. LPA observe a crib for infants use. Licensee stated she is not currently caring for any infants.

LPA discussed safe sleep regulation, making licensee aware no infant shall be swaddle and car seat shall not be used for sleeping, to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the child status. Licensee was informed all infants shall have an individual infant Sleeping Plan (UC 9227). Licensee should refer to regulation 102425(J) for documentation requirement. LPA reviewed requirement with licensee during this inspection visit. LPA informed licensee of the Child Care Licensing Safe Sleep web page at


https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-r esources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. To provide Incidental Medical Services, such as administering blood glucose monitoring, inhaled medications, Epi-pen and Epi-pen Jr., insulin shots, gastrostomy tube feeding and care, or carrying out other medical orders, it is best practice to complete a "Plan for Providing Incidental Medical Services•. This plan will help you ensure that you can provide this service in the safest manner possible. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.


SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: COOPER-WARREN FAMILY CHILD CARE
FACILITY NUMBER: 197700027
VISIT DATE: 03/15/2022
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SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: COOPER-WARREN FAMILY CHILD CARE
FACILITY NUMBER: 197700027
VISIT DATE: 03/15/2022
NARRATIVE
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SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: COOPER-WARREN FAMILY CHILD CARE
FACILITY NUMBER: 197700027
VISIT DATE: 03/15/2022
NARRATIVE
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SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 03/21/2022 04:41 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: COOPER-WARREN FAMILY CHILD CARE
FACILITY NUMBER: 197700027

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2022
Section Cited

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Mandated reporter certificate expired. This requirement was not met as evidenced by base on LPA record review the licensee mandated certificate expired.

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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: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6