197700033-9-24-2021-12-CC-BTSA-C76UDU-20210924153007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700033
Report Date: 09/24/2021
Date Signed: 09/24/2021 03:30:16 PM

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:	SILVA FAMILY CHILD CARE		FACILITY NUMBER:	197700033
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	09/24/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee Kumuduni Silva		TIME COMPLETED:	03:45 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 September 24, 2021 at 1:30PM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted a Case Management - Licensee Initiated inspection to increase capacity from a Small Family Child Care Home(FCCH) to a large FCCH. LPA disclosed the purpose of the inspection and was granted entry by Licensee's Spouse. Licensee greeted LPA upon entry and guided LPA on a tour of the FCCH. Upon entry, LPA observed 5 children in care. Incidental Medical Services (IMS) policy was discussed. The operating hours are Monday through Sunday 4:00AM - 11:30PM. This is a two story home with 4 bedrooms, 3 bathrooms, kitchen, living room, dining room, facility area, laundry room, storage room, computer room, and garage. There is no pool/spa or body of water on the premises. Per Applicant, the following areas are utilized for Family Child Care: living room and facility area. The home is gated from the front yard to the backyard. The off-limits areas include: laundry room, entire upstairs, (bedrooms #1, #2, #3, #4, bathrooms #2, #3, and computer room), and the garage. Stairs have a gate. There is no fireplace on the premises. The cleaning solutions (locked under kitchen sink and in off-limits garage) and medications (in top kitchen cabinet) are stored inaccessible to children. The knives are kept in off-limits garage inaccessible to children. Per the licensee there are no weapons or firearms of any kind in the facility at this time. LPA did not observe any weapons. The smoke and carbon monoxide detectors are in operable condition. The licensee was reminded that fire and disaster drills are to be conducted at least once every six months and logged. Last drill conducted 4/23/2021. The home had the required fire extinguisher (2A10BC) that meets State Fire Marshal standards (reading in green).

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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: SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 09/24/2021

NARRATIVE

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The facility's annual fees are current. The licensee had all the required licensing documents posted in the day care room visible to parents. LPA observed a current child roster. The outside back yard is used by the children for outside play (shaded area provided). The back yard is gated all around. The outdoor play area was inspected and was observed to be free of hazards, loose and sharp parts. Swing set observed to be anchored to the ground.
The following were discussed: Smoking is not permitted in the licensed facility. Baby walkers, baby jumpers, baby exersaucers, baby bouncers/rockers and any other items that fall into that category are not permitted in the facility.

The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your Analyst of any person who will be visiting regularly or for longer than one week. Licensee is aware all adults over the age of 18 years must be fingerprint cleared visiting regularly or for longer than one week.
Beginning on January 1, 2018, Assembly Bill 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. Applicants must meet requirements as a precondition to licensure. New employees shall complete training as required 90 days from date of employment. The training may be conducted at the following website www.mandatedreporterca.com. Mandated Reporter training completed 8/27/2020.

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: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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: SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 09/24/2021

NARRATIVE

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The licensee was reminded it is her responsibility to visit the department's website to obtain licensing forms, Quarterly Updates, and Provider PINs.

Fire clearance was granted on 06/09/2021 for a large FCCH with a maximum capacity of 14 children in care. Licensee is aware a qualified livescan cleared adult is required when more than 8 children are present. A capacity for a large family child care home(FCCH) has been approved with maximum 14 children pending submission of Lead Poisoning Prevention Certificate. Exit interview conducted and a copy of this report, appeal rights and notice of site visit were provided to Licensee.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

LIC809 (FAS) - (06/04)

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