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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700379
Report Date: 03/03/2020
Date Signed: 03/03/2020 11:27:35 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:FOX FAMILY CHILD CAREFACILITY NUMBER:
197700379
ADMINISTRATOR:FOX, CHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(302) 312-3042
CITY:SANTA CLARITASTATE: CAZIP CODE:
91387
CAPACITY:14CENSUS: 1DATE:
03/03/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cheryl Fox, ApplicantTIME COMPLETED:
11:05 AM
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On March 03, 2020 at 9:00 am Licensing Program Analyst (LPA) Monique Ayala and Licensing Program Manager (LPM) Mariela Ramon arrived at Fox Child Care Home for the purpose of conducting a change of location pre-licensing inspection. A fire clearance has been granted LPA Ayala and LPM Ramon met with applicant Cheryl Fox, who guided the LPA Ayala and LPM Ramon on a tour of the home. All adults residing in the home are fingerprint cleared and associated to the facility.

All areas identified on the facility sketch were inspected. This is a two story home with 5 bedrooms, 3 bathrooms, dining room, kitchen, backyard, and attached garage. This home has central Air and Heat. There is a swimming pool and spa on the premises. There is a 5 foot fence that separates the backyard area where children will play making the pool and spa inaccessible to children. The pool gate was tested and observed to to be self-closing/self-latching and it opens away from the bodies of water. LPA took photographs of the bodies of water.

The applicant has requested to operate Monday through Friday from 6:30 AM to 6:00 PM. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPA Ayala and LPM Ramon observed age appropriate safe toys.

Per applicant, main care will be provided in the living room and the playroom. Children will nap in the living room. Napping equipment was observed. LPM and LPA inspected a second bedroom located on the first floor and observed a door that gives direct access to the backyard area where the swimming pool and spa are located. Applicant stated the door that gives access to the backyard is always locked and the bedroom door located in the hallway will remain lock at all times when children are in care. Children will utilize the bathroom located in the hallway. The backyard was observed to be free of debris and any plants that are free of thorns. Applicant has plenty of age appropriate toys for children to utilize (little tikes tricycle, plastic slides and a playhouse) which are in good condition. LPA Ayala and LPM Ramon discussed safe sleep practices with applicant and provided safe sleep information.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
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 4
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: FOX FAMILY CHILD CARE
FACILITY NUMBER: 197700379
VISIT DATE: 03/03/2020
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The home was inspected as follows: Living room, Fire place (inaccessible to children), Dining room, Kitchen, five bedrooms, three bathrooms, attached garage, front yard, back yard and pool .
Areas that are inaccessible to children are as follows: All of upstairs area (3 bedrooms and 2 bathrooms), laundry room, attached garage, pool area. A safety gate was observed on the stairway leading to the second level of the home.

Applicant stated there are no weapons or firearms in the home. Applicant guided LPA Ayala to bedroom located on second floor, and showed LPA Ayala sword collection which was stored in a bedroom closet in upper shelf. The second story will be off limits to the children in care.

Fire extinguisher (2A10BC) is up to date. Applicant has a Carbon Monoxide detector located in the hallway, tested operable. The smoke detector in the hallway area tested operable. Medications were observed to be kept away from children in the upper kitchen cabinets. Cleaning products are kept in kitchen under the sink with child proof locks. The garage is attached but has a lock on the upper portion of the door.


Applicant has current pediatric First Aid and CPR which will expire 11/17/2020.
The following was discussed with the applicant:

· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.

· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: FOX FAMILY CHILD CARE
FACILITY NUMBER: 197700379
VISIT DATE: 03/03/2020
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· 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. The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.

· A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed.

· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
· Changes should be reported the to the Department as soon as they occur such as construction and remodeling
· Telephone number changes and/or if you move from home
· Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· Saucer chairs, bouncers, walkers, or any similar items are prohibited.
· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
· LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov


SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: FOX FAMILY CHILD CARE
FACILITY NUMBER: 197700379
VISIT DATE: 03/03/2020
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Safe Sleep Links:
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

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 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 facility is ready for licensure.

An exit interview was conducted with the applicant. This report was read by the applicant and agrees with the above. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4