197700174-9-8-2021-12-CC-CHEH-C6NK8N-20210908074102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700174
Report Date: 09/01/2021
Date Signed: 09/08/2021 07:41:18 AM

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:	ALLEN, CRYSTAL FAMILY CHILD CARE		FACILITY NUMBER:	197700174
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	09/01/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:02 PM
MET WITH:	Crystal Allen		TIME COMPLETED:	03:17 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 09/1/2020, at 1:05 PM Licensing Program Analysts (LPA) Carol Heath made an announced inspection with Licensee, Crystal Allen for the purpose of conducting a Capacity increase Pre-Licensing Inspection prior to licensure for a Large Family Child Care Home, and to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirements. Currently, there are 2 adults (Licensee and her daughter) and 6 children (Her daughter’s child (9 months), licensee’s son (15), 3 Grand children (8 and 13 years old), 2 Foster children (10 and 13 years old) living in the home. The hours of operation are Monday thru Friday 23 hours. The Licensee will provide breakfast, snack, and lunch. The licensee stated she is transporting children in care. The licensee has a pet dog which she states will not be around the day care children during the hours of operation. The Home is set up as follows: This is a two story family home which consists of 4 bedrooms, 3 bathrooms, a kitchen, family room, living room, laundry room, and attached garage. The off-limit areas include all four bedrooms, upstairs bathrooms, the laundry room, garage, and backyard shed. The stairs leading to the upstairs part of the home are properly gated, making it inaccessible to children. The garage is made inaccessible as it has two locks, although the garage door locks from the outside. The laundry room is made inaccessible to children as licensee has placed a child proof doorknob on the door. Family room: The family room, also known as the day care area, will be the primary location in which care is provided. There is a fireplace located in the family room which is made inaccessible to children with a glass barrier. The home has central heating and air conditioning. All windows are free of cracks, bugs and debris. There is no hanging window blinds cords (cordless) are inaccessible to children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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: ALLEN, CRYSTAL FAMILY CHILD CARE	FACILITY NUMBER: 197700174
	VISIT DATE: 09/01/2021

NARRATIVE

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Kitchen: All sharp utensils and cutlery, cleaning supplies, medicines; drawers and cabinets with plastic bags, and sharp things or small things children can swallow; are made inaccessible to children with child safety latches on sink cabinet and drawers. ; The refrigerator dishwasher, stove, microwave, etc., are clean.
Bathrooms: Children will use the downstairs bathroom located to the right of the laundry room. Bathrooms were toured, and inspected sink/toilet are in operable condition. Toilet and faucets are clean, safe and operable; bathtub and shower are free of hazard.
Electrical outlets: All unused electrical outlets are plugged and made inaccessible to children.
Play equipment and toys: Play equipment and toys are available. There are age appropriate safe toys observed.
Napping equipment: LPA observed napping equipment: playpen. Per Licensee the children are napping on the floor with their blanket. LPA Heath discussed the Safety Baby Sleep with Licensee and let her know the regulation.
Outdoor: The outdoor play area is clean and free from all debris or dangerous conditions. Play equipment (Swing and Slide set) was insecurely anchored according to manufacturer. Backyard is fully fenced. The other side a 6 foot fence that was unlocked gate. LPA also observed AC unit without a cover.
There is no working landline operable however Licensee reports using cell phone for communication of her facility.; smoke detectors and carbon monoxide detector tested operable. There is a fire extinguisher (2A10BC) in the kitchen. According to the licensee, she did not have a refill since 9/16/2019.
The first aid kit is complete and available and is store out of the reach of children (In the kitchen).
Pets: There is pet in the home (a dog). They have current vaccinations.
North Region Lancaster Department granted the facility fire clearance on 08/03/21.
All poisons are locked, and hazardous materials are kept inaccessible to children (upstairs Master Bedroom) .

Smoking is prohibited in the facility premises. Per Licensee, if food is brought from the children’s homes, the containers will be labeled with child’s name and properly stored or refrigerated.

Licensee states there are no weapons in the home or on the premises. The home does not have a swimming pool, spa, hot tub, fishpond, or any other bodies of water. Baby walkers, bouncers, jumpers, inclined sleepers and similar items will not be used for children in care and are kept inaccessible. A copy of home ownership will always be available at the home.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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: ALLEN, CRYSTAL FAMILY CHILD CARE	FACILITY NUMBER: 197700174
	VISIT DATE: 09/01/2021

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Emergency supplies are maintained in the closet. Emergency drills will be conducted every six months or more often depending on the date of enrollment of the children and a written log will be maintain. The Licensee is aware of current Safe Sleep Awareness information. Although the facility, at this time, will not provide Incidental Medical Services (IMS) such as: Administration of Blood Glucose Monitoring; Inhaled Medications; Epi-Pen and Epi-pen Jr. Insulin Shots; Gastronomy Tube Feeding and Care; or carrying out other medical order, the LPA explained that prior to providing any of the above IMS the facility is to complete a “Plan for Providing IMS” this plan must be approved by the Department. The American with Disabilities Act (ADA) and California disability laws were discussed.

Documentation:

Licensee has current CPR, First Aid Training with the expiration dates of 08-01-2022 and Prevented Health and Safety Training completed: 05-19-2020. All adults in the home have a fingerprint clearance and TB exam. Licensee has proof of being immunized against influenza, pertussis and measles. Licensee has proof of Mandated Reporting Training dated 07/14/2021. Per Licensee transportation will be provided. Licensee has valid California Driver License with expiration date 07-24-2023, valid vehicle registers and valid vehicle insurance.

The following was discussed with the Licensee:

Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter.
On January 1,2018 or before March 30,2018, a person who, is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. www.mandatereporterca.com

§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions :(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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: ALLEN, CRYSTAL FAMILY CHILD CARE	FACILITY NUMBER: 197700174
	VISIT DATE: 09/01/2021

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Licensee reminded that 100% supervision is required at all times to children in care. Licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is he/she responsibility to know the regulations as well as anyone who assists in providing 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 childcare 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.

All adults living in the home and assistant have received appropriate background clearance and child abuse central index (CACI) check and/or exemption. Requirements for fingerprint clearances and associations were discussed and verified with the licensee.

**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed childcare facility are aware of situations that present the greatest danger to children.

LPA explained that the Notice of Site Visit (LIC 9213) must remain posted for 30 days (during the hours that children are in care) after each site visit by a licensing representative. Also, any licensing report documenting a type “A” citation must be posted for 30 days during the hours that children are in care, and any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

Disability laws require a childcare facility undertake an individualized assessment of a situation if the childcare facility receives a request to provide incidental medical service as an accommodation to a child with disability.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC809 (FAS) - (06/04)

Page: 6 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: ALLEN, CRYSTAL FAMILY CHILD CARE	FACILITY NUMBER: 197700174
	VISIT DATE: 09/01/2021

NARRATIVE

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LPA Heath explained and went over the LIC 311D (Forms and Record to Keep in Your Family Child Care Home form) and told Licensee that during future home inspections, the Licensing Program Analyst will also review all the required forms and information that you must keep on file in your home.

LPA remind Licensee that she shall familiarize with the guidelines established by the American Academy of Pediatrics to help reduce the risk of Sudden Infant Death Syndrome (SIDS) when caring for infants. ·Safe Sleep in Child Care: Resources can be found on our website at
http://www.cdss.ga.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

·Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb ,or call them at (510) 620-5600.

Licensee was advised to often review Community Care Licensing (CCL) Child Care section of the public Community Care Licensing web site at https://www.cdss.ca.gov/inforesources/child-care-licensing because it contains the most current up-to-date information regarding CCL Quarterly Updates, forms, regulations, Corona virus Disease (COVID-19) and Provider Information Notices (PINS). The LPA told the Licensee that it is the licensee responsibility to know the regulations as well as anyone who assists in providing care. Also that the inaccessibility of hazards and active supervision must be constantly reassessed depending on the children in care. In addition, CCLD has established a dedicated e-mail address to receive public inquiries related to COVID-19, cclcovid-19info@dss.ca.gov

The Licensee was advised of the requirement to maintain a current contact phone number and to submit written reports of unusual incidents and/or injuries report (UIR) by telephone, fax, mail or email within the next business day following the occurrence during the operation of family day care home. Additionally, if reported to CCL by telephone, submit written report within seven (7) calendar days of the event. Describe what happened and be specific. Include Child's name, date of birth/age, sex and date of admission; date and nature of the event; Attending physician's name and findings and treatment, if any, and Disposition of the case; enter date, month and when the child's authorized representative was notified, etc. If available, use Unusual Incident/Injury Report - Family Child Care Home form LIC624B. Keep a copy of the report submitted to CCL in the (affected) child's record.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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: ALLEN, CRYSTAL FAMILY CHILD CARE	FACILITY NUMBER: 197700174
	VISIT DATE: 09/01/2021

NARRATIVE

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Licensee advised visit www.shotsforschool.org for Immunization information.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

Prior to being licensed the follow is required by: Due 9/6/2021
* A/C unit shape blades needs to be made inaccessible ·
* Backyard Play equipment (Swing and Slide set) needs to securely be anchored according to manufacturer.

**As a result of this inspection, the home does not meet Title 22 Regulations. Corrections are required.

LPA Heath provided a copy of the original Facility Evaluation Report (LIC 809) to the licensee: Crystal Allen

Exit Interview conducted.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC809 (FAS) - (06/04)

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