197700297-7-16-2019-12-CC-LKIG-BE5MVU-20190716095719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700297
Report Date: 07/16/2019
Date Signed: 07/16/2019 09:57:35 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:	BYRNE FAMILY CHILD CARE		FACILITY NUMBER:	197700297
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	07/16/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	April Byrne		TIME COMPLETED:	10:00 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) Lady King-Lewis, met with Applicant, April Byrne for the purpose of conducting a Pre-Licensing inspection for a Small Family Day Care Home (SFDCH) *maximum capacity (including children residing in provider’s home under 10 years of age) is 6 children, with no more than 3 infants, (if infants only, the maximum capacity is 4 infants only) or 8 children when 2 are at least 6 years of age and with a maximum of 2 infants. Applicant states all adults living in the home have submitted fingerprints clearance and fingerprints have been associated to the day care license. Applicant is aware a person shall not be employed, an assistance, a substitute care providers or volunteer at a family day care home if he or she has not submitted fingerprints clearance and have 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. Currently residing in the home: The applicant, applicant boyfriend, and 3 minor children. Applicant states no pets in the home. Applicant was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, Applicant must be notify the assigned LPA. Applicant uses personal cell phone at this time.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: BYRNE FAMILY CHILD CARE	FACILITY NUMBER: 197700297
	VISIT DATE: 07/16/2019

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. Applicant states at this time no IMS is provided. Applicant aware a plan of operation for IMS shall be submitted to assigned LPA. 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

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Call the On Duty officer of the day within 24 hours to report the unusual incident/injury and send the Unusual/Injury Report within 7 days to office.

Applicant and LPA toured the home inside and outside. LPA observed a single story, 3 bedrooms, 2 bathroom home with kitchen, dining area, living room, Linen closet, laundry room, 2 car garage and rear yard. Applicant states the Home off limit areas are all bedrooms, and garage. The garage is used for storage only and no child care activities are conducted in garage. The area of the Home accessible to the children are dining area, living room, hallway bathroom, and rear yard. There is a fireplace located in the dinning area, inaccessible to children with a glass screen barrier. The home has central heating and air conditioning. Outside air conditioner units have safe gate around the unit. There is no pool, spa or other bodies of water on the premises.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

Page: 2 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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: BYRNE FAMILY CHILD CARE	FACILITY NUMBER: 197700297
	VISIT DATE: 07/16/2019

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
26
27
28
29
30
31
32

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents, cleaning compounds, medications, sharp knives, and hazardous items that can pose a danger to children are inaccessible, locked up. All unused electrical outlets have safety covers. Per licensee, there are no weapons or firearms of any kind in the home. LPA did not observe any weapons. Licensee aware all fire arms and any other weapons are not loaded and are locked up. Ammunition is stored and locked away separately form firearms. Smoke detectors and carbon monoxide detector were tested and operable. LPA observed a 2A:10BC fire extinguisher in kitchen area of home. The fenced outside play area is free from defects or dangerous conditions. Toys and playthings are safe, clean and appropriate for the age of the children to be placed in care. Children will nap in the designated nap areas with adult supervision.

The following was discussed with the Applicant:
Applicant aware a fire and disaster drills shall be conducted at least once every six months, and document the date and time of each drill.

The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B.

The "Notification of Parent's Rights" (Palmdale Regional Office) poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

Page: 3 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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: BYRNE FAMILY CHILD CARE	FACILITY NUMBER: 197700297
	VISIT DATE: 07/16/2019

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
26
27
28
29
30
31
32

The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a Type A violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties per violation will be assessed. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports. 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 and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered too.

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 were reviewed. Applicant reminded that 100% supervision is required at all times to children in care. Applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.

Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home designated for children in care. (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: BYRNE FAMILY CHILD CARE	FACILITY NUMBER: 197700297
	VISIT DATE: 07/16/2019

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
26
27
28
29
30
31
32

- AB 2621 – Public information posted on the internet, effective January 1, 2015 – In accordance with California Health and Safety Code Section 1596.819 - The Department shall post licensing information for Family Child Care Homes on its Internet Web site to include:
· The Name
· The Status of the license
· The number of citations
· The number of site inspections, including
· Non-complaint inspections
· Substantiated and inconclusive complaint inspections
This information will be updated at least monthly on the website and will span the preceding five-year period.

Child Care Advocates information: childcareadvocatesprogram@cdss.ca.gov

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

Before licensure the following shall be completed:
1) Stove cover for kitchen stove
2) Licensee's parent board will post the following: Emergency Disaster, License, The Notification of Parent's Right's, Notice of Site Visit, and Preparedness Checklist. Recommended posting: Plan, Safety Seat Belt Law, Shaken Baby Syndrome, SIDS,
3) Age appropriate napping equipment shall be available.
4) Property Owner/Landlord Consent form LIC 9149
5) copy of Rental/Lease Agreement
An exit interview was conducted and a copy of this report was provided to the licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

Page: 5 of 5