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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304204569
Report Date: 01/29/2020
Date Signed: 01/29/2020 12:37:20 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:HANVEY, DEBRAFACILITY NUMBER:
304204569
ADMINISTRATOR:HANVEY, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 771-2236
CITY:ORANGESTATE: CAZIP CODE:
92866
CAPACITY:14CENSUS: 8DATE:
01/29/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Debra HanveyTIME COMPLETED:
01:00 PM
NARRATIVE
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An Annual required inspection was conducted at the facility by Licensing Program Analyst (LPA), Jungmi Han. LPA observed licensee and assistant caring for 8 of children which included 2 of infants, 6 preschool age children. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 1 adult (including the licensee) and 1 of minor children living in the facility.

During today’s inspection, LPA Han arrived at 10:15AM. LPA observed 6 children were playing outdoor activity area. LPA entered facility outdoor area through unlocked broken wooden gate. LPA observed 6 children were playing outdoor area without supervision. LPA sat on bench and supervised outdoor children from 10:15AM to 10:19AM. LPA observed a child came out from indoor through closed patio glass door. LPA met assistant who was changing diapers for two children at the children’s bathroom which is inside of facility. LPA met licensee who was working in kitchen. Licensee stated assistant should call licensee for help before changing children’s diaper.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to child care children. Off limits areas are made inaccessible by means of gate. The child care area includes the family room which is accessed through the backyard and kitchen. The children walk through the child care room to the bathroom. Licensee stated the children's primary area is the child care room. There are working carbon monoxide, smoke detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children.
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HANVEY, DEBRA
FACILITY NUMBER: 304204569
VISIT DATE: 01/29/2020
NARRATIVE
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Licensee stated there are not firearms and/or other dangerous weapons in the facility and none were observed during today's inspections. There is no fireplace in the child care room. The home has age appropriate toys for the ages served. LPA verified there is a working telephone service. There were no poisons or other items observed which could pose a danger to children. There are no bodies of water on the premises.

The licensee does have a current roster of children in care. LPA received a copy of roster. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. The licensee’s Pediatric CPR/First Aid certification expired 10/6/2020. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, 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. Proof of immunization against pertussis, measles for assistant was not within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.
Licensee does not provide Incident Medical Services at this time. 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 licensee understands she must be present in the facility and must ensure children in care are supervised at all times and children are not to be left in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.



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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HANVEY, DEBRA
FACILITY NUMBER: 304204569
VISIT DATE: 01/29/2020
NARRATIVE
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CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through www.ccld.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website.
A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Based on LPAs observations, record reviews, and interviews the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 102417 (a), and Health and Safety 1597.622(a)(1) are being cited on the attached LIC 809D

Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. An exit interview conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.



End of Report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HANVEY, DEBRA
FACILITY NUMBER: 304204569
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/29/2020
Section Cited

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102417 (a) Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times...the licensee shall arrange for a substitute adult to ...supervise ...This requirement is not met as evidenced by:
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Based on observation and interview, the licensee failed to ensure to supervise children in care at all times. LPA observed there are no supervision for children in outdoor activity area for at least 4 minutes at 10:15AM. This poses an immediate Health and Safety risk to the children in care.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HANVEY, DEBRA
FACILITY NUMBER: 304204569
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/29/2020
Section Cited

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1597.622(a)(1) Employee and Volunteer Immunization (1) Commencing September 1, 2016, a person shall not be employed...family day care home if he or she has not been immunized against influenza, pertussis, and measles...This requirement is not met as evidenced by:
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Based on record review of staff#1, licensee is missing proof of Pertussis, Measles, and influenza vaccine. The licensee failed to ensure to maintain Staff#1's immunization records. This poses a potential Health and Safety risk to the children in care.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 5 of 5