197700200-7-18-2019-12-CC-DMAX-BE7NMU-20190718103539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700200
Report Date: 07/18/2019
Date Signed: 07/18/2019 10:35:59 AM

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:	ADENIRAN, ADRIANNE FAMILY CHILD CARE		FACILITY NUMBER:	197700200
ADMINISTRATOR:	ADRIANNE ADENIRAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 920-3354
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	14	CENSUS: 1	DATE:	07/18/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Adrianne Adeniran		TIME COMPLETED:	10:53 AM

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), Maddox met with applicant, Adrianne Adeniran for the purpose of conducting an Pre-licensing inspection. Present today were applicant and her niece. The home is a 2 story family home with 4 bedrooms and 3 bathrooms. **There are no pools, spas or any other bodies of water on the premises. All adults in the home, applicant only has fingerprint clearances and exam for T.B. Applicant will use 2 family rooms; backyard; dining are; and the front bathroom are designated for child care. Fireplace is screened and home has central heating and air conditioning. The kitchen and bathroom were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children. The outside play area was clear of chemicals and debris, the entire yard is fenced. All unused electrical outlets are plugged and play equipment and toys are available. Applicant is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility. Applicant has current CPR and First Aid training (exp 11/2019). Per applicant, there are no weapons or firearms of any kind on the premises. The required fire extinguisher (2A 10BC), smoke detector is operable. LPA informed applicant she is responsible for maintaining a current Roster and must document Emergency Disaster drills no less than twice a year.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: ADENIRAN, ADRIANNE FAMILY CHILD CARE	FACILITY NUMBER: 197700200
	VISIT DATE: 07/18/2019

NARRATIVE

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Applicant can access forms on line at www.ccld.ca.gov . LPA observed all required forms posted; Regulation prohibits the smoking of tobacco in any licensed facility. LPA informed applicant/applicant of the Departments Child Care Advocate’s (CCA’s) that can forward Quarterly updates regarding Child Care Licensing’s’ Rules and Regulations. You may contact the Child Care Advocate Program directly: Phone number: (916) 654-1541
Email address: childcareadvocatesprogram@dss.ca.gov

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

Issued applicant the following: SIDS information and Shaken Baby Syndrome pamphlet – For more information on SIDS and Safe Sleep Environments, please visit:

California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training:

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: ADENIRAN, ADRIANNE FAMILY CHILD CARE	FACILITY NUMBER: 197700200
	VISIT DATE: 07/18/2019

NARRATIVE

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******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 o 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 - not at this time

**§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. –

§1596.8662 (b) (1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. mandatedreporterca.com

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: ADENIRAN, ADRIANNE FAMILY CHILD CARE	FACILITY NUMBER: 197700200
	VISIT DATE: 07/18/2019

NARRATIVE

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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 child care facility are aware of situations that present the greatest danger to children.

**Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family child care homes shall post during hours of operation. **Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty. In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report documenting the Type A citation and sign form LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to. Staff is aware of required forms for children's files and forms that shall be posted after licensure.

During this inspection, LPA provided the following to applicant:

***Safe Sleep Information
***Roster
***LIC 311
***Car Safety Sleep

Applicant, needs to purchase a Carbon Monoxide Detector: Fire Clearance has been received for the Large Capacity Child Day Care. Exit Interview conducted a copy of this report is discussed and left at the facility.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

LIC809 (FAS) - (06/04)

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