304310224-8-16-2019-06-CC-STOE-BF4P2X-20190816105640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304310224
Report Date: 08/16/2019
Date Signed: 08/16/2019 10:56:47 AM

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:	KELLY, TATIANA		FACILITY NUMBER:	304310224
ADMINISTRATOR:	KELLY, TATIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 337-8394
CITY:	LAHABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	14	CENSUS: 14	DATE:	08/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Tatiana Kelly		TIME COMPLETED:	11:01 AM

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 unannounced inspection was conducted at the facility by Licensing Program Analyst (LPA) Torrence. LPA met with Tatiana Kelly who guided analyst on a tour of the Early Childhood Setting indoors and outdoors. Licensee’s Assistant Deshano Kelly was also present. During today’s inspection, there was 14 children present. Licensee has 14 children enrolled. Licensee does not have a current children’s roster available. Licensee states that two adults and three children live in the home. Operation hours are 6:00 a.m. to 7:30 p.m.; Monday through Friday. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This is a single-story home which consist of four bedrooms, two bathrooms, kitchen, dining room, living room, laundry room, enclosed patio (daycare room), attached garage, front yard (not fenced), and back yard (fenced). The licensee has designated the off-limit area as such; four bedrooms, one bathroom, laundry room, front yard, and attached garage. The licensee has designated the daycare area as the following; kitchen, living room, enclosed patio (day care room), one bathroom located in the hallway, and backyard. The daycare area was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning supplies, medication, and hazardous items that can pose a danger to children. Per licensee there are no weapons or firearms in the facility. There were age appropriate toys and learning material. Fire/disaster drill log was not updated. Outdoor play activity is in the backyard. Licensee stated that she is always present when children are outside playing. The required fire extinguisher (2A10BC), smoke detector, and carbon monoxide detector were in operable condition. First Aid kit was complete. Licensee and three assistants did not have proof of current CPR/First Aid cards. Children's records: parents' rights and California School Immunization Record were reviewed. Child #1 file was missing immunization records.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

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: KELLY, TATIANA	FACILITY NUMBER: 304310224
	VISIT DATE: 08/16/2019

NARRATIVE

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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

Licensee had proof of immunization against pertussis, measles, and influenza. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Licensee and her three assistants have not completed the Mandated Reporter Training. Website provided: http://mandatedreporterca.com/. Licensee was informed how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. LPA provided licensee with the Effects of Lead Exposure handout.

During this inspection, LPA observed the following deficiencies and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Sections 102417(g)(8) Operation of a Family Child Care Home,102418(a) Immunizations, and 102416(c) Personnel Requirements. The deficiencies are being cited on the attached LIC 809D. The following Technical Violation is given in accordance with H&S 1596.8662 Mandated Reporter Training and Technical Assistant is being given in accordance with CA Code of Regulations, Title 22, Division 12, Section 102417(g)(9)(A) Operation of a Family Child Care.

Exit interview was conducted. Report reviewed and discussed with the licensee. Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: KELLY, TATIANA	FACILITY NUMBER: 304310224
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/16/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/23/2019 Section Cited CCR 102417(g)(8)	1 2 3 4 5 6 7	102417(g)(8) Operation of a Family Child Care Home .Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. The requirement is not met as evidence by record review. Licensee does not have a current children's roster	1 2 3 4 5 6 7	Per Licensee, she will submit a current children's roster to LPA by POC due date.
	8 9 10 11 12 13 14	this poses a potential risk to the safety of children in care.	8 9 10 11 12 13 14
Type B 08/23/2019 Section Cited CCR 102418(a)	1 2 3 4 5 6 7	102418(a) Immunizations. Prior to admission to a family day care home, children shall be immunized against diseases......The requirement is not met as evidence by record review of C #1. C#1 is missing proof of immunization vaccines. This poses a potential risk to the health of children in care.	1 2 3 4 5 6 7	Per LIcensee, she will submit Child #1 immunization records to LPA by POC due date.
Type B 08/23/2019 Section Cited CCR 102416(c)	1 2 3 4 5 6 7	102416(c) Personnel Requirements. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid... Licensee/assistants.This poses a potential risk to the safety of children in care do not have proof of current CPR/1st.	1 2 3 4 5 6 7	Per LIcensee, she will submit proof of CPR/1st Aid card to LPA by POC due date.

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

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