197700386-1-14-2022-12-CC-LKIG-CANR34-20220114113920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700386
Report Date: 01/14/2022
Date Signed: 01/14/2022 11:39:39 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:	COLLINS FAMILY CHILD CARE		FACILITY NUMBER:	197700386
ADMINISTRATOR:	COLLINS JOCELYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 300-0163
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	14	CENSUS: 0	DATE:	01/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Jocelyn Collins		TIME COMPLETED:	11:54 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) King-Lewis conducted a required 1 year Inspection with licensee who guided analyst on a tour of the home day-care areas. This is a single story family home. The day care take place in the following area of the home: family room, dinning area, hallway bathroom and rear yard. Licensee states the day care hours of operation is 6:00 AM to 6:00 PM Monday thru Friday. Currently living in the home is licensee and licensee's 6 minor children (4, 4, 4, 6, 14, 16). Physical Plant: There are no body of water on the premises. Licensee stated there are no firearms or other dangerous weapons. Storage areas for poisons, are kept under kitchen sink with a kiddy lock and in laundry room inaccessible to children. Medication are stored in bedroom #1/licensee lock bedroom. Detergents, cleaning compounds and other items which could pose a danger to children are inaccessible to children stored in laundry room with kiddy knob on door. No fireplace observed in home. Fire extinguishers, smoke detectors, and carbon monoxide are operable at time of inspection. LPA observed the home to be orderly, central air and heating available. There is a land line telephone and a cell phone available for the license day care.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COLLINS FAMILY CHILD CARE	FACILITY NUMBER: 197700386
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above, LPA did not observe a current fire drills and disaster drills log which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/14/2022
	Plan of Correction
1 2 3 4	Licensee will conduct drills and forward copy of drill log to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

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: COLLINS FAMILY CHILD CARE	FACILITY NUMBER: 197700386
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)(1)

Admission Procedures and Authorized Representatives Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above LPA did not observe a sign Notification of Parent's Rights LIC 995A form for child 1 signed by parent which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/21/2022
	Plan of Correction
1 2 3 4	License shall have parent sign form and forward a copy to LPA.

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 Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: COLLINS FAMILY CHILD CARE	FACILITY NUMBER: 197700386
	VISIT DATE: 01/14/2022

NARRATIVE

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LPA did not observed a crib or play pen in license day area of the home. Licensee stated she is not currently caring for any infants.

LPA discussed safe sleep regulation and informed licensee to refer to regulation 102425(J) for documentation requirement. LPA reviewed requirement with licensee during this inspection. Licensee shall supervise infants while they are sleeping by physically checking every 15 minutes and documenting the child status in writing. Licensee was informed all infants shall have an individual infant Sleeping Plan (LIC 9227). Licensee aware no infant shall be swaddle, car seat shall not be used for sleeping, LPA provided Child Care Licensing Safe Sleep webpage as an additional resource: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
LPA 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.
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

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: COLLINS FAMILY CHILD CARE	FACILITY NUMBER: 197700386
	VISIT DATE: 01/14/2022

NARRATIVE

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Care and Supervision
Licensee is aware she must be present in the home 80% of the operating hours and shall ensure that children in care are supervised at all times. Licensee states she do not provide transportation at this time. LPA informed licensee to make sure the transportation vehicle is proper insured to transport day care children. Licensee is aware the capacity stated on the facility license shall be the maximum number of children being cared for at one time.

Facility Records Review
LPA observe facility current roster of children, and current mandated reporter training certificate. Licensee did not observe current fire and disaster drill. Licensee is aware that all employees or volunteer at the day-care shall be immunized against pertussis and measles and maybe immunized against influenza.

Facility Administration
Licensee 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.
Licensee aware to immediately remove individual and prevent individual for returning to the home or having contact with children in care upon notice from the

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: COLLINS FAMILY CHILD CARE	FACILITY NUMBER: 197700386
	VISIT DATE: 01/14/2022

NARRATIVE

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department to remove an individual and all individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in the license home. Licensee is aware any authorized employee of the Department may enter and inspect any place providing personal care and services at any time with or without advance notice. Licensee is aware other personnel shall complete training on preventive health practices including CPR and first aid per regulation 102416 (c). Licensee CPR and first aid card expires 09-11-2023.

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B per the regulation.
During this inspection facility was observed not to be in compliance with Title 22. Please see LIC 809D for deficiencies.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the licensee a copy of this report and a notice of site visit was given and must remain posted for 30 days

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

LIC809 (FAS) - (06/04)

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