197700188-10-29-2019-12-CC-VHUT-BHEVVG-20191029164619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700188
Report Date: 10/29/2019
Date Signed: 10/29/2019 04:46:32 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:	JENSEN FAMILY CHILD CARE		FACILITY NUMBER:	197700188
ADMINISTRATOR:	JENSEN, CAROLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 305-8760
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 10	DATE:	10/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Carole Jensen, Licensee		TIME COMPLETED:	05:00 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	Licensing Program Analyst (LPA) Victoria Hunt met with Carole Jensen licensee, who guided analyst on a tour of the facility for an annual random inspection. Upon arrival children were observed to be playing in the play area, a total of 10 children were observed to be in care. Residing in the home includes: adult (licensee), her spouse, adult, and minor children. Per LIS, facility annual fees are current. All adults working in the facility have been background cleared. Licensee is operating within ratio/capacity during the time of inspection. Licensee was observed providing adequate supervision during the time of this inspection. The licensee's assistant was present during this inspection. This facility operates from 7:00 am- 5:00 pm. Monday through Friday. The home was inspected as follows: Living room, family room, kitchen, dining room, garage backyard and the bedrooms and bathrooms that are not off limits. This is a single -story home with 4 bedrooms, 3 bathrooms, there is a bonus room located off the garage. This home has a kitchen/dining, living/family room and attached garage. The home was inspected for safety, comfort, cleanliness, telephone service, central air and heat and ventilation. Also for inaccessibility to poisons, detergents, cleaning compounds, medicines, and other hazardous items that can pose a danger to children. Main care is conducted in the playroom (room #1 ), living room and the back yard areas. In room #1, the playroom LPA observed, age appropriate furniture tables and chairs that were in good condition. There are various age appropriate toys that the children have access to play with.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 197700188
	VISIT DATE: 10/29/2019

NARRATIVE

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Cubbies were observed in the playroom in which children can store their belongings. Learning/educational material was posted throughout the walls of the playroom. Books, games and toys were stored on shelves and were in sanitary condition. There is a dual fireplace that opens up to the playroom and the living room sections of the home. The fireplace screened with plywood board and is inaccessible to children.

A kitchen was observed to be located near the playroom. The kitchen was inspected for proper storage of all cleaning detergents, medications, and sharp pointed objects. During this inspection the kitchen was observed to be clean and in good repair. All cabinets observed to have cleaning/detergent items, scissors/sharp objects, and medication were observed to be inaccessible to children; by magnetic locks.

In the living room, LPA observed a wooden entertainment center that is secured and bracketed to the wall. The master bedroom is located down the hallway, children will utilize the bathroom that is located in the master bedroom. The bathroom was inspected during this inspection. LPA observed an operational sink and toilet. Cabinets were free and clear of debris and hazardous items. There is a pool that can observed from master bedroom and living room areas.

Doors that have access to the backyard were observed to have alarms that alert the licensee when the doors are opened. The backyard was inspected and observed. The backyard is dirt/grass landscaping. There is an grassy area for active play. Three sheds were observe to be in the backyard that were observed to be locked. Two large dogs were observed to be located in the dog run surrounded by chain link fencing. This facility has a pool on the premises which was inspected during the time of this inspection. The pool is completely surrounded by mesh fencing that was at least 5 foot high. The mesh fencing material is in good repair. The mesh fencing is constructed so that it does not obscure the view of the pool. The mesh gate swings away from the pool. The pool has a self-closing latch located no more than four inches from the top of the gate. The mesh gate is able to close by itself with no assistance. Pool can be observed through glass doors in the kitchen and through a doors located in the master bedroom.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 197700188
	VISIT DATE: 10/29/2019

NARRATIVE

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Licensee is not providing any medical services. LPA advised 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

**Licensee informed to review updates/regulations for 2016/2017 /2018 on the department website: www.ccld.ca.gov ; AB 1207 - all child care employees must complete mandated reporter training beginning January 1, 2018; AB 1387 - and AB 2236 process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles, and TB clearance, beginning September 1, 2016; AB 2231 Effective July 1, 2017 - Civil Penalty Amount changes. AB 1207 Mandated Reporter Training, and Safe Sleep Regulations.

This facility was evaluated in accordance to licensing laws and regulations to ensure the health and safety of children. No deficiencies were cited today. This facility was found to be in substantial compliance. An exit interview was conducted with the licensee and a copy of this report was left at the facility. An Notice of Site Visit was posted and issued during today’s visit. Notice of Site Visit must remain posted for 30 consecutive days. Failure to do so will result in an immediate civil penalty assessment of $100.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

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: JENSEN FAMILY CHILD CARE	FACILITY NUMBER: 197700188
	VISIT DATE: 10/29/2019

NARRATIVE

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LPA reviewed children and staff records, the records were complete. Licensee and her assistant have been immunized for pertussis, measles, and influenza. Immunization's were observed. Licensee has completed AB 1207 Mandated Reporter Training.

All required licensing document were posted near the main entrance of the door; located in the hallway. All electrical outlets were properly covered. The home is clean, orderly, comfortable and well ventilated. This facility has a dual smoke/carbon monoxide detector. The smoke detector was working during the inspection but the carbon monoxide was not operational condition during the time of this inspection. This poses a immediate risk to children in care. A fire extinguisher 2A10BC was observed to be on the premises that meets fire marshal standards. The home has a working telephone service available. Per licensee, disaster/fire drills are conducted every six months. LPA observed disaster/fire drill log as current.

This home was clean, orderly and comfortable for children in care. This facility has a first aid kit on premises. LPA observed that licensee has a Pediatric CPR and First Aid that is valid until 04/2021 and her assistant's Pediatric CPR and First Aid is valid until 04/2021. Copy obtained for file. This facility has a current roster.

Off limit areas include: Laundry, garage and all bedrooms and bathrooms that are inaccessible to children in care. There is a security gate that prevents children from accessing the off limit bedrooms.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

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