<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311139
Report Date: 07/08/2019
Date Signed: 07/08/2019 11:23:27 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:SEGUIN, ELWYNFACILITY NUMBER:
304311139
ADMINISTRATOR:SEGUIN, ELWYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 420-3259
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:14CENSUS: 8DATE:
07/08/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Elwyn Sequin - LicenseeTIME COMPLETED:
11:40 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 annual visit was conducted today by Licensing Program Analyst (LPA), Gigi Mai and Licensing Program Manager (LPM) Judy Hanson. Met with licensee, Elwyn Seguin, and 2 assistants, and licensee guided LPA/LPM on a tour of the facility. Present at the time of the inspection were 8 day care children, 2 of them are infants and 1 school-age. A review of adults living or working in the home on this date indicated individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The floor plan was verified; the main day care areas are the living room, kitchen, dining room and 2 bedrooms. The master bedroom, master bathroom, and garage are off-limits areas are made inaccessible by means of key lock/latches. Licensee acknowledges that children are never to enter an off-limit area of the home. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medication, sharp knives and hazardous items that could pose a danger to children. The fireplace is screened and inaccessible to children.

Licensee stated there are no firearms on the premises. LPA advised anytime when firearms are present, they must be locked and stored separately from the ammunition. No swimming pool, spa or other bodies of water observed on the premises. There are age appropriate toys and napping equipment on the premises for the ages served. The required fire extinguisher (2A10BC), carbon monoxide, and smoke detectors are in operable condition.

Licensee had disaster/fire drill log (drill conducted on 04/2019), children’s roster, and children’s records on file. LPA Mai reviewed children's files for immunization records and parent’s rights. The licensee's pediatric CPR/First Aid certification is current, which expires 05/05/2020. Proof of immunization against pertussis and measles for licensee and assistants was available for review. The mandated reporter certificates were verified by LPA. (Page 1 of 2)

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gigi MaiTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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 2
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: SEGUIN, ELWYN
FACILITY NUMBER: 304311139
VISIT DATE: 07/08/2019
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
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed, applicant stated he does not plan to provide it at this time. 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 licensing office within 30 days of providing IMS. The plan should describe the facility’s policies and procedures that ensure the proper safeguards are in place. 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 following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to presence in the facility. There is to be no smoking, no infant walkers, no Johnny jumpers, no exersaucer or any other similar items that fall into that category allowed in the facility. Reviewed disaster drills, posting requirements, children record’s, mandated child abuse, and injury/death reporting, and criminal records clearances/exemption transfer requests.

A Child Care Provider’s Guide to Safe Sleep packet, Safety Seat, Never Ever Shake a Baby information and were recommended to be posted. Safe Sleep Regulation and Effects of Lead Exposure were discussed and provided to the applicant. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf. The below links offer more information on safe sleep to our providershttps://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. [End of Report]

(Page 2 of 2)

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gigi MaiTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2