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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313514
Report Date: 02/16/2021
Date Signed: 02/16/2021 02:24:55 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:JOHNSTON, YUKARIFACILITY NUMBER:
304313514
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
02/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator Johnston Yukari and Assistant Noah Johnston. TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced in-person Pre-Licensing inspection for a new Large Family Child Care home. LPA met with applicant Ms. Johnston Yukari along with the assistant Mr. Johnston Noah who provided a tour of the new home. Fire clearance from the Orange County Fire Authority was received and approved for a large family childcare home.
A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances exemptions is received and is cleared.

Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes to notify the licensing office.

The applicant is requesting a Large family childcare home license. Per applicant, operation hours will be Monday to Friday, 8.00 AM to 6.00 PM care and supervision shall be provided to children ages 6 months to 6 years (Infants to Preschool age).

On today’s inspection upon arrival LPA observed two assistants with four Preschool age children and one infant receiving care and supervision. Assistants present at the home have the required clearances and documents on file.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story home with 4 bedrooms, 2.5 bathrooms, living room, dining room, family room, kitchen, laundry room, a bonus room, garage, and backyard that is fenced.

Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a central Air/ Heating system, the A/C unit is in the side yard and the area is inaccessible to children. (Page-1)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
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: JOHNSTON, YUKARI
FACILITY NUMBER: 304313514
VISIT DATE: 02/16/2021
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Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock.

Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant has placed the second story, kitchen, family room, garage, as off limits and has placed child proof gates, door locks, and doorknob covers to prevent the children from entering the off-limit areas during operation hours. The applicant acknowledged the children may never enter the off-limit areas, Laundry room on the first level of the home and has a locked stopper installed making it inaccessible to children. Kitchen is made inaccessible by placing a child safety gate across the dining area and Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen are all inaccessible stored in upper cabinets. Home has a stairway leading to the second level of the home and a Fireplace in the Day care area. Stairway has a safe barrier across it and the Fireplace has a glass door installed making it inaccessible to children.
Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: The children shall enter through the main entrance of the home into the small hallway. The applicant has designated the Living area, bonus room, dining room, bathroom downstairs, (In front of the family room) and the backyard as part of her day-care.

Upon entering the designated Day care area, applicant shall receive the children here, no visitors are allowed beyond this point, upon entrance temperatures shall be checked, hands shall be sanitized, and the children shall be guided into the designated day care areas.

COVID-19 guidelines and precautions were discussed with the applicant.

The bathroom is in front of the family room, it was observed to be safe and free of hazardous items. Sink cabinets has no hazardous items. It was observed to be safe and clean.

OUTDOOR PLAY AREA: Applicant have designated back yard area for outdoor activities, it was observed to be fenced on all the sides. LPA observed age appropriate toys placed under the shaded patio area and there is a barbecue island in the backyard which did not have a gas canister attached and safe for children.

LPA have recommended to place a cover the Barbecue. (Page-2)

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
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: JOHNSTON, YUKARI
FACILITY NUMBER: 304313514
VISIT DATE: 02/16/2021
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Per applicant, there are no pets in the home.

Per applicant there are no firearms, weapons or bodies of water on the premises.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

There are toys and educational items available for children.

Younger infants nap in the crib and older children nap on the mats, linens are brought from home.
Applicant states that food shall be provided to the children including lunch with snacks and Breakfast.

Applicant and the Assistant s have completed the required Health and Safety with Nutrition and Lead Poisoning component Training and Pediatric First Aid and CPR which expires on 5/2022. There are first aid supplies available.

The following was discussed with the applicant:
·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.

Civil Penalties will be assessed if not in compliance.
·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 Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.
·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
Applicant was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

Reporting Requirements: 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. (Page-3)

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
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: JOHNSTON, YUKARI
FACILITY NUMBER: 304313514
VISIT DATE: 02/16/2021
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Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

UPDATE: H&S 1597.622: Commencing September 1, 2016, 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.
The applicant has submitted proof of immunization's.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com


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. (PAge-4)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
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: JOHNSTON, YUKARI
FACILITY NUMBER: 304313514
VISIT DATE: 02/16/2021
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A copy of “A Child Care Providers Guild to Safe Sleep” was provided to applicant:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.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
LPA reviewed with applicant the following safe sleep best practices:
· 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 and not be too hot or too cold.

A copy of the PIN 2--24 was provided to the Licensee as Infant care is being provided.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:



Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

The facility is in compliance for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection, in the event additional requirements are needed, the applicant will be notified. Notice of Site visit was provided to the Licensee on today's inspection. No deficiencies cited. Appeal rights were presented and Exit interview was conducted with the applicant Ms. Johnston Yukari.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5