198020761-4-23-2021-33-CC-RLOZ-C2CTDA-20210423143802

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020761
Report Date: 04/23/2021
Date Signed: 04/23/2021 02:38:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KALAYCI FAMILY CHILD CARE		FACILITY NUMBER:	198020761
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/23/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Maral Kalayci		TIME COMPLETED:	01:30 PM

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	An announced Pre- Licensing Inspection was conducted by Licensing Program Analyst (LPA) Roxana Lopez and Licensing Program Manager (LPM) Brandi Van Oosten. Due to COVID-19 and precautionary measures this Pre- Licensing Inspection was conducted via a tele-inspection by the use of zoom, with applicant Maral Kalayci. The purpose of today's visit is to inspect and evaluate facility for initial licensure, Applicant is applying for a Small Family Child Care Home. Present during this inspection was applicant and her son. Per applicant, operation hours will be Monday to Friday, 7:30 AM to 5:30 PM. Applicant states that she will care for children 2-10 years of age. During this tele-inspection the Licensee took Licensing staff on a tour of the home. The following was observed: All areas identified on the facility sketch were inspected, including but not limited to, all off limit areas. This is a one-story home that consists of 3 bedrooms, 2 bathrooms, kitchen, dinning room, living room, front yard and backyard. Per applicant, the children will use the restroom in the hallway, the living room, dinning room and backyard fence. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service via cell phone, ventilation and heating. LPA did not observed cleaning compounds and other hazardous items that can pose a danger to children. The applicant states that there are poisons on the premises located in a shed. LPA observed shed not to be locked- Per licensee she will be placing a lock to make it inaccessible. ---------------------------------------------------------Pg.1 of 6 -----------------------------------------------------------------------------

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

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 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KALAYCI FAMILY CHILD CARE	FACILITY NUMBER: 198020761
	VISIT DATE: 04/23/2021

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Based on the Facility Sketch submitted, areas off limits to children and parents are: The front yard, kitchen, 3 bedrooms and one bathroom. All areas inaccessible for children were observed to have a lock making them inaccessible. Per applicant, she will also be placing a gate to make that whole area inaccessible. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA Lopez observed two fire extinguishers- in the kitchen and one in the shed. However the fire extinguishers were not the required 2A10BC fire extinguishers. Per applicant she will buy the required fire extinguisher and replace it. At 9:17am applicant tested the smoke and carbon monoxide detectors. LPA Lopez and LPM Van Oosteen observed them and heard them to be operable.

There are toys available for children. Licensing staff observed sleeping arrangements in forms of cots. The applicant states that she will not be caring for infants.

The applicant states that they will provide food for children in care.

The applicant has completed the required Health and Safety Training, Nutrition and Lead Training on 9/4/2020 and Pediatric First Aid and CPR with expiration date of 11/2022 There are first aid supplies available.

Per applicant, there are no firearms, weapons or bodies of water on the premises. Licensing staff did not observed any bodies of water.

OUTDOOR PLAY AREA
The children will use the back yard for outdoor play, which was observed to be fenced. LPA did observed a shed in the back yard that was not locked. Two grills and a hose in the play area. Per applicant she will place a lock on the shed, move the grills and hose out of the play area to make them inaccessible for children. Applicant moved the grills during inspection. LPA observed a door in the backyard leading into the master bedroom which was locked. Per applicant, there is one dog in the facility. LPA observed the dog to be outside behind a gate making him inaccessible, Per applicant the dog will remain gated during day care hours.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

LIC809 (FAS) - (06/04)

Page: 2 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KALAYCI FAMILY CHILD CARE	FACILITY NUMBER: 198020761
	VISIT DATE: 04/23/2021

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. 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

At 10:00 AM 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. Civil Penalties will be assessed if not in compliance.
· 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 Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
· 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 replaced as needed.
· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Reporting Requirements: 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.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KALAYCI FAMILY CHILD CARE	FACILITY NUMBER: 198020761
	VISIT DATE: 04/23/2021

NARRATIVE

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· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

· Immunization Requirement: H&S 1597.622: 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. The licensee and all adults working with children have proof of immunizations.

· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

At 10:30 am LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. All required forms listed were explained during the visit and were provided via email to the applicant prior to the visit.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

OTHER INFORMATION AND FORMS PROVIDED:
· Handouts provided for Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices
· Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.
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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KALAYCI FAMILY CHILD CARE	FACILITY NUMBER: 198020761
	VISIT DATE: 04/23/2021

NARRATIVE

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Licensing staff consulted with applicant regarding COVID-19 health and safety guidelines on this date, applicant was provided forms to post via email. Licensing staff observed COVID- 19 postings posted in the day care on this date. During this inspection LPA discussed PIN 20-06 CCP, Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education. LPA reviewed with the applicant the Child Care Covid-19 Self-Assessment guide that the applicant filled out before this inspection.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Licensee is seeking to provide care for 8 children 2-10 years old.

Based on licensing staff observations, the following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due 4/30/2021 .

• Applicant states that they will buy a lock to make shed inaccessible to children in care. Applicant states that she will submit a picture as proof of correction.

• Applicant states that she will buy the correct fire extinguisher 2A10BC. Applicant states that she will submit a picture by due date as proof of correction.

• Applicant states that she will removed/cover the hose from the play area to make the inaccessible for the children in care. Applicant states that she will submit a picture by due date as proof of correction.

Once corrections are submitted, the application will be submitted for final review to the department. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KALAYCI FAMILY CHILD CARE	FACILITY NUMBER: 198020761
	VISIT DATE: 04/23/2021

NARRATIVE

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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Maral Kalayci, Applicant via tele-inspection (zoom), during which appeal rights were explained. This report along with a copy of appeal rights will be sent to the Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

LIC809 (FAS) - (06/04)

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