304205632-5-14-2019-06-CC-GCOY-BC6RSL-20190514131656

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304205632
Report Date: 05/14/2019
Date Signed: 05/14/2019 01:17:01 PM

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:	PRESLEY E. SUSAN		FACILITY NUMBER:	304205632
ADMINISTRATOR:	PRESLEY E. SUSAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 362-3935
CITY:	ALISO VIEJO	STATE: CA	ZIP CODE:	92656
CAPACITY:	14	CENSUS: 5	DATE:	05/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Susan Presley		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 annual inspection was conducted today by Licensing Program Analyst (LPA) Connolly. Present was licensee and five children in care two of whom infants. Upon arrival all children were playing in the fenced backyard. The licensee was present here as well. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. The facility was toured inside and out. The following areas were checked: facility clean and in good repair, hazards inaccessible or locked, fire extinguisher, carbon monoxide detector and smoke detector operational, fire drills documented, stairs barricaded, fire place screened, bodies of water inaccessible, guns locked, roster complete, children immunizations documented and maintained, Notification of Parents Rights provided to parents or authorized representatives, and pediatric CPR First Aid cards current. Home, clean and in good repair, is two story attached. Licensee has designated the downstairs for the care and supervision of children. Kitchen is off limits. Toys and educational material that appear age appropriate for ages served are located in the living room redesigned as a play room.. Gate is in place at the bottom of the staircase and gates are in place to prevent entry to kitchen. The fire extinguisher, smoke detector and carbon monoxide detector are within regulation. Disaster drills are practised and documented. The fire place is screened. Licensee's pediatric CPR and First Aid health cards are current until 7/29/19. The fenced backyard is designated as the area for outdoor play by children in care. Toys and outdoor play equipment appear age appropriate for ages served. Cushioning material is underneath and surrounding climber/slide. Licensee said when children in care are playing in the fenced backyard 100% visual supervision is provided. This was observed today. Continued on page two

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: PRESLEY E. SUSAN	FACILITY NUMBER: 304205632
	VISIT DATE: 05/14/2019

NARRATIVE

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Licensee maintains immunization records for children in care and licensee has provided parents or authorized representatives a copy of the Family Child Care Home Notification of Parents' Rights.
Licensee had certificate of completion of the mandated reporter training and provided proof of immunity to Measles and Pertussis.

There are no bodies of water, no pets and licensee denies firearms on the premises.

During today’s inspection LPA discussed incidental medical services with the licensee. Licensee said there are no incidental medical services being provided at this time.

LPA discussed the following regarding the care of infants:Always place infants on their backs for sleeping. Use only a tight fitting sheet on the crib or play yard mattress. Do not hang any items from the crib or above the crib. Keep all items, including blankets, out of the crib or play yard. Pacifiers may be used as long as they do not have items attached to them. Infants should not be swaddled or have any items covering them while sleeping. The temperature of the room should be comfortable enough for an adult to wear a T-shirt or not be too hot or too cold.

In the areas that were evaluated no deficiencies were observed of the California Code of Regulation, Title 22, and Division 12 at the time of the inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100.00. The 'Notice of Site Visit' ' must be posted on or adjacent to the door. Failure to post Type A reports for 30 days will result in a civil penalty of $100

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019

LIC809 (FAS) - (06/04)

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