197700033-6-3-2022-12-CC-BTSA-CF2W2Z-20220603165511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700033
Report Date: 06/03/2022
Date Signed: 06/03/2022 04:55:19 PM

Document Has Been Signed on 06/03/2022 04:55 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:	SILVA FAMILY CHILD CARE		FACILITY NUMBER:	197700033
ADMINISTRATOR:	SILVA, KUMUDUNI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 723-5230
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	14	CENSUS: 7	DATE:	06/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:04 PM
MET WITH:	Licensee Janaka Silva		TIME COMPLETED:	05:10 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 June 3, 2022 at 2:04PM, Licensing Program Analyst (LPA) Brigitte Tsutaoka met with Licensee, Janaka Silva, who guided analyst on a tour of the facility for an Annual Random inspection. This is a two story 4 bedroom, 3 bathroom home with kitchen/dining, living room, family room, laundry room, and garage. There is no pool/spa or body of water on the premises. Hours of operation are Monday through Friday 6:00AM to 5:00PM. Upon arrival LPA observed 7 children. Family members residing in the home include 3 adults (both licensees and licensee adult child). Incidental Medical Services (IMS) policy was discussed. Main care is provided in living room. Children use the bathroom in hallway. Off limit areas include entire upstairs (4 bedrooms and 2 bathrooms), laundry room, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (garage), medicines (none on premises), and hazardous items (sharp knives outdoor kitchen in off-limits garage) that can pose a danger to children. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. There is AC and heat. Home is clean and orderly, there is no fireplace on the premises. There are age appropriate toys and play equipment, working smoke detector and carbon monoxide. LPA observed required fire extinguisher (2A10BC), no one smokes in the home, no prohibited items in the home. There is a designated area for ill child(ren) in the family room. Per Licensee, there are no weapons/firearms on the premises. LPA did not observe any during inspection. Facility has working available telephone (cellphone for both Licensees). Poisons, medication and cleaning items are inaccessible to children. Window coverings are cordless.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

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: SILVA FAMILY CHILD CARE	FACILITY NUMBER: 197700033
	VISIT DATE: 06/03/2022

NARRATIVE

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Safe and age appropriate toys, play equipment and materials are available for children. Electrical outlets are inaccessible, no baby bouncers/saucer chairs, or any recalled and or prohibited toys or sleep/play equipment were observed on the premises. There are age appropriate napping equipment (mats and play pin).

Bathroom: Downstairs restroom does not have shower/bathtub. Sink and toilet available for child use. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. LPA observed hand washing flyer in restroom. Toilet and faucet are clean and operable.

Kitchen: The following are inaccessible: Sharp items, plastic bags, cleaning items, no chemicals in the kitchen were observed accessible. Cabinets have safety latch. There is a fully stocked refrigerator/freezer. Breakfast, lunch and snacks are served. Facility provides meals for children.

Outdoor: Backyard has safe/age appropriate outdoor toys/equipment available for the children and is fenced all around. Outdoor play structure is anchored to ground. Outdoor equipment, bikes, and toys are in good repair without rough or sharp parts.
First Aid kit was observed with supplies (thermometer) readily available. Licensees have CPR/First Aid (Expires: 01/14/2023 and 03/17/2023) and Mandated Reporter (Expires 03/22/2024 and 8/27/2022). Licensee does no have liability insurance. Child files reviewed. LPA observed one infant (not in attendance) file missing the Infant Sleep Plan (LIC9227) and the Chart identifying the 15 minute interval checks/notations detailing infant status during nap. Facility conducts checks visually, but has not documented the checks. LPA provided technical assistance during inspection explaining importance of the Infant Sleep Plan, infant stages of development in relation to safe sleep, and the explanation of the 15 minute chart. LPA also provided an example of the chart and a blank LIC9227 for facility to utilize. Required documents posted.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: unusualincidentreport@dss.ca.gov).

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

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: 06/03/2022

NARRATIVE

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A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

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

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, inspect the facility. The Licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

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: 06/03/2022

NARRATIVE

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility in compliance per Title 22 Regulations and no deficiencies were cited during inspection. Technical assistance was provided regarding safe sleep documentation.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with Licensee Janaka Silva.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

LIC809 (FAS) - (06/04)

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