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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313659
Report Date: 10/09/2019
Date Signed: 10/09/2019 03:29:34 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:CALKINS, LAURA & MICHAELFACILITY NUMBER:
304313659
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
10/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Laura & Michael CalkinsTIME COMPLETED:
04:10 PM
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An inspection was conducted at the facility by LPA, Dean Valencia. 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. There are presently 3 adults living in the home.

During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. Today's inspection as to approve an increase in capacity to 14, to be a large FCCH. An approved Fire Inspection Request STD850 was received by the licensing office on 10/8/19. There were 5 children in care at the time of the inspection. It was observed that the provider is operating within compliance of ratio, and a printout of ratio was provided and discussed. The floor plan was verified. Off limits areas are made inaccessible by means of baby gate. The staircase is off limits to children. The licensee's pediatric CPR/First Aid certification is current, which expires 6/2021. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisonous items are not stored on site, and none were observed during today's inspection. There is a working carbon monoxide detector, smoke detector, and fire extinguisher in the home.

Exit interview was conducted, and this report was reviewed and discussed. Notice of Site Visit was posted during the visit. The licensee was informed that the Notice of Site Visit must be posted for 30 consecutive days from today's date. Failure to post and remain posted will result in civil penalties of $100 per day. The licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. and accessibility/information about the website was discussed with the provider. This report is to be on file and accessible for public review at the facility, for the next 3 years.

The increase in capacity is tentatively approved as of today's date, 10/9/19, pending a managerial approval.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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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