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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700503
Report Date: 09/02/2021
Date Signed: 09/02/2021 01:36:05 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:BARNES FAMILY CHILD CAREFACILITY NUMBER:
197700503
ADMINISTRATOR:TERRY BARNESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 333-2897
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:14CENSUS: 0DATE:
09/02/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Applicant Terry BarnesTIME COMPLETED:
01:45 PM
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On September 2, 2021 at 10:00AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka met with Applicant, Terry Barnes, who guided LPA on a tour of the facility for a Pre-licensing inspection. This is a single story 4 bedroom, 2 bathroom home with kitchen/dining, den (also labeled "day care room"), office, living room, and garage. There is no pool/spa or body of water on the premises. Family members residing in the home include 2 adults (applicant, applicant's daughter) and two children. Incidental Medical Services (IMS) policy was discussed.

Main care is provided in den (adjacent to Bedroom 3 leading to back yard). Children use the Bathroom 1 in hallway across from the kitchen. Off limits areas include Bedroom #1 through #3, Bathroom #2, kitchen, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (locked under kitchen sink), medicines (locked in hallway closet) and hazardous items (sharp knives in upper kitchen cabinet) that can pose a danger to children. Applicant reminded to conduct fire/earthquake drills every 6 months and document. A Roster was provided to Applicant to complete and maintain. The office has two steps leading down to the den. The steps have gate.

The backyard is completely fenced. There is a large tree that provides shade. Two dogs are kept in dog run on side yard, made inaccessible to children by gate. Age appropriate outdoor toys are available for child use and seating for outdoor meals. LPA observed a gate with unlocked side gate leading to front yard accessible in backyard. During inspection, Applicant obtained padlock and secured side gate, preventing front yard access.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 197700503
VISIT DATE: 09/02/2021
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Per Applicant, there are no weapons or firearms on the premise. LPA did not observe any in the home at this time. There are age appropriate toys. Age appropriate napping equipment (mats). The required fire extinguisher (2A10BC), smoke detector, and carbon monoxide detector are in operable condition. Fireplace has locked screen and is made inaccessible by safety gate. Home has central AC and heat. CPR/First Aid expire 04/02/2023. Preventive Health and Safety completed with 1 hour child nutrition and lead exposure prevention 6/27/2021 and 6/29/2021. The First Aid kit was observed and is complete with touchless thermometer.

The following was discussed with the Applicant:
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 . 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, licensing must be notified. 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 where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

--Applicant is advised visit www.shotsforschool.org for Immunization information.
--Applicant was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640
--Family Child Care Providers (Disaster Planning information): https://ccld.family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Videos: https://ccld.childcarevideos.org
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 197700503
VISIT DATE: 09/02/2021
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--Applicant advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
--Provider Information Notice (PIN) Summary - PIN 18-02-CCP; Family Child Care Providers (Disaster Planning information):https://cccld.childcarevideos.org/family-child-care-providers/disaster-planning-and-fire-safety/

Applicant 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 LIC624. Pamphlet Information regarding SIDS, Safe Sleep requirements, and Notification of Parent's Rights poster (Palmdale Regional Child Care Office) were provided. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. .

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

Requirements for fingerprint clearances and associations were discussed with the Applicant. The applicant was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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: BARNES FAMILY CHILD CARE
FACILITY NUMBER: 197700503
VISIT DATE: 09/02/2021
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Applicant informed to review Quarterly updates/regulations for 2017-2021 on the department website which includes information on: AB 1207 - all child care employees must complete mandated reporter training beginning January 1, 2018 and complete by March 30, 2018; AB 1387 - and AB 2236 process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 277 - require all children attending day care or school based programs to be immunized and will eliminate personal/religious belief exemptions.

Applicant 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 serious 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 in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).

The On Duty Worker is available for questions at 661-202-3318 Monday through Friday 8am-5pm. LPA provided consultation during the inspection.

COVID-19 Technical Assistance was conducted during inspection.

Facility is in compliance per Title 22 regulations. No corrections are needed at this time. The application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12 or 14 with parent notification.



An exit interview was conducted, and a copy of this report was read and provided to the Applicant on this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4