198400221-5-25-2021-54-CC-MRIA-C3CQGP-20210525120950

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400221
Report Date: 05/24/2021
Date Signed: 05/25/2021 12:11:20 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	LUCKEY FAMILY CHILD CARE		FACILITY NUMBER:	198400221
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	05/24/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	03:42 PM
MET WITH:	Kelly Luckey, Licensee		TIME COMPLETED:	04:50 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	On Monday, May 24, 2021 at 3:45 PM, Licensing Program Analyst (LPA) Mayra Rivera conducted a Capacity increase inspection for a Large license via teleconference. This pre-licensing inspection conducted by LPA Rivera, due to COVID 19 and precautionary measures the inspection was conducted via teleconference using Zoom. The teleconference was conducted with Licensee Kelly Luckey who guided LPA Rivera on a tour of the facility. Family members residing in the home has been discussed with applicant. The licensee is requesting for a large family childcare home license. Operating hours will be Monday to Friday, 6:00 AM to 6:00 PM and care for children ages 0 to 12 years. This facility is a two story home that consists of three (3) bedrooms, one and half (11/2) bathroom, kitchen, living room, den, front yard (gated), backyard (fenced) and garage. Areas that are accessible to children and identified on the facility sketch were inspected by LPA Rivera; den, living room, kitchen, dining room, half restroom and backyard. Per applicant, children will utilize the backyard (fenced) for outdoor play. Per applicant, parents will utilize the front door living room entrance for pick up and drop off. Areas off limits to children include: stairs, upstairs 3 bedrooms, 1 bathroom, closet (washer and dryer), shed and garage. At 3:47 PM, LPA observed a safety gate installed on the bottom of the stairs as a barrier. Off limits areas, LPA observed the doors closed and locked with a dead bolt lock. LPA inspected for safety, comfort, cleanliness, telephone service, and ventilation. At 3:48 PM, LPA Rivera observed thermostat for heater and the vents located on high ceiling wall. LPA did not see a fireplace during the inspection, LPA observed 2 children in care.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUCKEY FAMILY CHILD CARE	FACILITY NUMBER: 198400221
	VISIT DATE: 05/24/2021

NARRATIVE

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At 3:50 PM LPA Rivera observed child proof locks installed inside the kitchen bottom drawers and cabinets. LPA asked where are the cleaning solutions stored, and Licensee stated above the stove top cabinet. LPA observed cleaning solutions inside the top cabinet . LPA observed kitchen knives and sharp objects inside the kitchen drawer with a child proof lock installed.

In the child care room, LPA observed age appropriate toys, furniture, napping equipment and cubbies. LPA Rivera observed covers on the outlets and at 3:58 PM LPA observed the bathroom in good condition with working toilet, running water, toilet paper, hand soap, paper towels. LPA observed child proof locks on the bathroom cabinets. Inside the medicine cabinet, LPA did not observed any medication. LPA observed a hair comb.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated there is "no", pets, poisons, firearms, weapons or bodies of water. LPA did not observe pets, poisons, firearms, weapon or bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately. Licensee was advised that if food is brought from the children’s home, all containers must be labeled with the child’s name and properly stored or refrigerated

At 4:02 PM, LPA Rivera asked licensee to press on the smoke detector and carbon monoxide and LPA Rivera heard the sound of the detectors. Smoke detector is operating and located in the hallway and the carbon monoxide alarm is operating an located in the livingroom. Fire extinguisher is located in the den and LPA Rivera observed the valve on the fire extinguisher 2A-10BC on the green area which indicates fully charged and purchase receipt May 2, 2020. LPA informed it has been a year and the fire extinguisher either needs to be serviced or purchase another extinguisher. First Aid kit located in the bathroom.

For outdoor play, children will be utilizing the backyard. At 4:08 PM LPA Rivera observed a shed locked with a key pad lock. The backyard has two side metal gates and both gates have a self latch lock (high reach). The backyard has enough shade provided by the trees and age appropriate toys (ex: balls, playhouse, toddler bikes, kid size basketball court) .

LPA asked Licensee if she will be providing Incidental Medical Service (IMS) and licensee stated yes she will be providing IMS. LPA Rivera explained the process and the plan and applicant stated she understood.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUCKEY FAMILY CHILD CARE	FACILITY NUMBER: 198400221
	VISIT DATE: 05/24/2021

NARRATIVE

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Licensee has proof of pediatric First Aid/CPR certification (expires 06/30/2022) and has proof of immunization against pertussis, measles and LPA received influenza declination dated May 19, 2021. The applicant completed the preventative health and safety training on 4/25/2020 and mandated reporter (AB 1207) training on 4/17/2020. The applicant was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.

The following was also discussed with Licensee:
1. Individuals who are 18 years of age or older and living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day civil penalty.
2. 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/child/infant CPR and Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
3. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.
4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.
5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
6. 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.
7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.
8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.
9 Smoking is prohibited in the family childcare home.
10. Children and staff records must be maintained and updated as needed and be available for review by the Department

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUCKEY FAMILY CHILD CARE	FACILITY NUMBER: 198400221
	VISIT DATE: 05/24/2021

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LPA Rivera and Licensee Kelly Luckey discussed protocol in place in regards COVID 19. Licensee stated protocol in place is having parents not fully enter the facility, and each family has their own clipboard and pen and sign in/out out takes place at the front door entrance. Licensee conducts temperature checks with a non touch thermometer. Licensee visually scans the children for any symptoms such as fever, running nose, cough, or child's behavior and will inform parent, child cannot stay if any symptoms related to Covid 19 or if symptoms appear during the day. The kitchen/den area is used as the Isolation area. Children wash their hands during arrival, entering the facility from outdoor play, meal times, covering their cough and using the restroom. Licensee stated she is aware of cleaning, disinfecting and sanitizing high traffic areas and common areas and the importance of the constant hand washing.

Fire clearance was received on May 11, 2021 and granted for 14 children. Correction needed will be to service the fire extinguisher or buy a new one and show purchase receipt and submit proof by June 24, 2021.

A final review of the application will be completed prior to licensure. Once licensed, the licensee is required to adhere to the terms and limitations stated on the license.

Upon receipt, Licensee shall post the Notice of Site Visit. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview was conducted with Licensee Kelly Luckey, via teleconference. This report along with Appeal Rights will be sent to the Licensee via email with a read receipt to confirm receipt of the report

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

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