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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700409
Report Date: 03/24/2020
Date Signed: 03/24/2020 12:22:38 PM

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:MILLER FAMILY CHILD CAREFACILITY NUMBER:
197700409
ADMINISTRATOR:MILLER, BEVERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 349-1612
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 1DATE:
03/24/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Beverly MillerTIME COMPLETED:
12:35 PM
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On March 24, 2020 at 9:45 AM, Licensing Program Analyst (LPA) Loyce Phillips arrived at Miller Family Child Care for the purpose of conducting an announced pre-licensing relocation inspection. LPA met with Licensee, Beverly Miller who guided analyst on a tour of the home. Applicant is requesting to operate a Large Family Child Care Home with the capacity of 14 children. Currently residing in the home is applicant, 2 adult sons and minor granddaughter. Days/hours of operation 7 days a week less than 24 hours. Licensee is aware that there must be an awake staff present when children are in care. Applicant and LPA toured the home indoor and outdoor to ensure the home meets licensing requirements.

The home is set up as follows: This a two story home with 5 bedrooms, 3 bathrooms, living room, dining room, kitchen, laundry room, family room and attach garage. Per applicant the following areas of the home will be utilized for the Family Child Care: The living room, dining room, bathroom #1 adjacent to the family room in the hallway to the right.

The off-limits areas of the home includes the entire upstairs which includes 4 bedrooms, 2 bathrooms and laundry room. The remaining off limits areas includes the kitchen, family room, backyard and attached garage. A safety gate is in place, making upstairs inaccessible. The garage and bedroom #1 is made inaccessible by child safety door knobs. The kitchen and family room is inaccessible by child safety gate. The home has central air conditioning and heat. All sharp knives are kept in a container in an upper kitchen cabinet. Poisons and medications are made inaccessible kept in the laundry room and master bedroom. Bathrooms were toured and inspected, sinks and toilets are in operable condition.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
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: MILLER FAMILY CHILD CARE
FACILITY NUMBER: 197700409
VISIT DATE: 03/24/2020
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Smoke detectors are in operable condition. The home has a working Carbon Monoxide detector. The applicant's Pediatric CPR/First Aid expires on 11/05/2021. The applicant had the required immunization against pertussis (TDAP) and measles (MMR). The applicant completed the required Mandated Reporter training on 3/5/2018.

The following was discussed with the applicant:
Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; The applicant was reminded that 100% supervision is required at all times to children in care; Applicant was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

The applicant was informed that all adults living in or having access to the home, or are employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working with children. 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 analysis of any person who will be visiting regularly or for longer than one week. The applicant was advised to utilize the Request for Livescan Service LIC9163 to have adults fingerprinted and associated to the home.

The applicant was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
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: MILLER FAMILY CHILD CARE
FACILITY NUMBER: 197700409
VISIT DATE: 03/24/2020
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The applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. 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 LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
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: MILLER FAMILY CHILD CARE
FACILITY NUMBER: 197700409
VISIT DATE: 03/24/2020
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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 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 applicant was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

Applicant is approved for a license pending managers approval.

An exit interview was conducted and a copy of this report was provided to the Licensee Beverly Miller.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4