197700033-1-2-2020-12-CC-LPHS-BKFTXR-20200102140733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700033
Report Date: 01/02/2020
Date Signed: 01/02/2020 02:07:42 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:	SILVA FAMILY CHILD CARE		FACILITY NUMBER:	197700033
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	01/02/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Kumuduni Silva		TIME COMPLETED:	02:15 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 January 2, 2020 at 11:40 AM, Licensing Program Analyst (LPA) Loyce Phillips met with Licensee, Silva Kumuduni, who guided analyst on a tour of the home for a Random/Annual Inspection. This is a two story single family home. The home has 4 bedrooms, 3 bathrooms, living room, family room, kitchen, dining room, and attached garage. There are no pools and spas, however, there is a fountain in the front yard that is drained and covered by artificial grass. Present during inspection were Licensee, licensee's spouse, licensee's twin daughters and 2 child care children. Days/hours of operation are 7 days a week, less than 24 hours. Licensee is aware there must be an awake staff at all times while children are in care. Main care is provided in the child care room (the room at the rear of the home) Children use bathroom #1 located in the hallway next to the family room. Children utilize living room, child care room, dining room, kitchen and backyard. Off limits areas include all 4 bedrooms and 2 bathrooms located upstairs. The stairs are inaccessible to children by use of a gate. Also, the garage and laundry room are off limits and made inaccessible to children. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation. Poisons, detergents, cleaning compounds, medicines and hazardous items that can pose a danger to children were inaccessible. Backyard is completely bricked off. There are no pets on the premises. Per Licensee, there are no weapons or firearms on the premise. LPA did not observe any in the home. There are age appropriate toys. Age appropriate napping equipment (mats). The required Fire Extinguisher (2A10BC), Smoke Detector and Carbon Monoxide Detector are in operable condition. Home has central AC and heat. CPR/First Aid expire 03/19/2021. Mandated Reporter was completed on 03/21/2018. Licensee has required immunization. The First Aid kit was observed and is complete.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

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: SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 01/02/2020

NARRATIVE

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LPA reviewed 2 children files for immunization records and signed Notification of Parents' Rights form.

Requirements for fingerprint clearances and associations were discussed with the Licensee. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents.

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation (call within 24 hours and submit the report within 7 days) and on the form LIC624B.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If this requirement is not met, civil penalties in the amount of $100 per violation will be assessed.

The following was discussed with the Licensee:

Capacity requirements, Notification of Parent's Rights, Roster requirements (keep updated names and blue sheet), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that supervision is required at all times to children in care. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified.

Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

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: SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 01/02/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. No Incidental Medical Services are currently being provided. 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.html

Licensee informed to review Quarterly updates/regulations for 2015-2019 on the department website: Summer 2015 - Incidental Medical Services information.

--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.

--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Licensee was advised visit www.shotsforschool.org for Immunization information.

The On Duty Worker is available for questions Monday through Friday at (661) 789-6944 from 8:00 AM - 5:00 PM.

No deficiencies cited. A copy of Safe Sleep Proposed Regulations was provided to Licensee. LPA provided consultation during inspection.

An exit interview was conducted and a copy of this report was read and provided to Licensee Kumuduni Silva.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020

LIC809 (FAS) - (06/04)

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