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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700220
Report Date: 08/16/2022
Date Signed: 08/16/2022 03:02:54 PM


Document Has Been Signed on 08/16/2022 03:02 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:DAVIS, TOSHA FAMILY CHILD CAREFACILITY NUMBER:
197700220
ADMINISTRATOR:TOSHA DAVISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 429-9780
CITY:QUARTZ HILLSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 10DATE:
08/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Tosha Davis, LicenseeTIME COMPLETED:
03:10 PM
NARRATIVE
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On 08/16/22 Licensing Program Analysts (LPAs) Justeene Tamayo and Andrew Alemoh met with Licensee, Tosha Davis, who guided analyst on a tour of the facility for the One Year Required inspection. This is a two story, 4 bedroom, 3 bathroom home with kitchen/dining, family room, living room, laundry room and garage. There is a spa or body of water on the premises. Upon arrival LPAS observed 8 preschool and 2 infants in care. Family members residing in the home include 3 adults (licensee, licensee husband, and licensee's daughter) and no children. Facility operation are Monday-Friday 7AM-4 PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room, family room, and dining room. Children use the bathroom in hallway on the left. Off limit areas include all bedrooms, bathrooms #2 and #3 (upstairs), laundry room (barricaded gate), and garage (has a key lock door knob). The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry room and under kitchen sink with safety latch), medicines (upper kitchen cabinet) and hazardous items (sharp knives in upper kitchen pantry unreachable to children in care) that can pose a danger to children. LPAs observed the fireplace to be barricaded. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5


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: DAVIS, TOSHA FAMILY CHILD CARE
FACILITY NUMBER: 197700220
VISIT DATE: 08/16/2022
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LPAs observed a saucer chair in the backyard area. Licensee removed the saucer chair. Licensee signed a declaration stating no day care child will use prohibited or recalled sleep/play equipment. LPAs reminded licensee that no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment are allowed on the premises. There is a designated area for ill children as necessary on the porch area. Per Licensee, there is one firearm on the premises. LPAs observed two safes with a key code. Per licensee, one safe is for the ammunition, and the other safe is for the firearm following Title 22 regulations. The facility sketch is complete and current, there is working telephone (cell).

Last fire/disaster drill was completed on 05/20/21. LPAs reminded licensee a fire drill must be completed and documented every 6 months, including the time and date of each drill. Licensee will conduct a fire/disaster drill today and send proof of completion to LPA Tamayo.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPAs did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in the kitchen (off limit area). Breakfast, lunch, snacks and dinner are provided. Licensee currently has a food program. Naps are provided on mats in the living room, dining area, and family room.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
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: DAVIS, TOSHA FAMILY CHILD CARE
FACILITY NUMBER: 197700220
VISIT DATE: 08/16/2022
NARRATIVE
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Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). There is no body of water. LPAs observed age appropriate toys. LPAs also observed the barbeque pit and hot tub fully covered making it inaccessible to children in care. Per licensee, there is one pet on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 07/29/2024. Licensee could not find her mandated reporter training. Licensee will complete the mandated reporter training at www.mandatedreporterca.com and send a copy to LPA Tamayo no later than 08/16/22. There are no window cords accessible to children.

Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC 9227). LPAs discussed and provided a copy of Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227) to licensee. Licensee stated currently does not have child care insurance.

During inspection, LPAs observed adult #1 in the home without a fingerprint clearance. Facility will be cited a Type A citation. An immediate $500 civil penalty will be assessed. Please see LIC809-D.

Licensee Davis 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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/16/2022 03:02 PM - It Cannot Be Edited

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: DAVIS, TOSHA FAMILY CHILD CARE
FACILITY NUMBER: 197700220

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. LPAs observed adult #1 in the home without a fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/16/2022
Plan of Correction
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Licensee will have adult #1 fingerprinted today 08/16/22. LPAs reminded licensee, adult #1 cannot reside in the home until adult #1 fingerprints are cleared. LPAs observed adult #1 leave the home.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5


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: DAVIS, TOSHA FAMILY CHILD CARE
FACILITY NUMBER: 197700220
VISIT DATE: 08/16/2022
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LPAs discussed the safe sleep regulations with licensee Davis 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. LPAs 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.

A notice of site visit was given to licensee 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 the licensee Tosha Davis along with her appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5