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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313659
Report Date: 05/04/2023
Date Signed: 05/04/2023 04:14:07 PM


Document Has Been Signed on 05/04/2023 04:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CALKINS, LAURA & MICHAELFACILITY NUMBER:
304313659
ADMINISTRATOR:CALKINS, LAURA & MICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 331-5765
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY:14CENSUS: 5DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee, Laura CalkinsTIME COMPLETED:
04:30 PM
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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Aiddee Nunez and Licensing Program Manager (LPM) Thuy Ho. LPA and LPM met with licensee, Laura Calkins and census was taken. There were 5 children which included 2 of infants and 3 preschool age children in day care area. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have not received criminal record and child abuse index clearances or exemptions. Currently there are 3 adults including the licensee living in the facility. Licensee’s daughter Krista calkins does not have a caregiver background check. Facility Day care hours are 7:30am-5:30pm, Monday through Friday.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to child care children. Off limits areas are made inaccessible by means of garage and the upstairs area. The child care area consist of the living room which is accessed through the dinning room. The children walk through the dinning room to the bathroom. Licensee stated the children's primary area is the living room. There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspections. The home has age appropriate toys for the ages served. During today’s inspection. LPA and LPM verified there is a working telephone service (cellular service). Licensee stated they use an outdoor play area. There were no poisons or other items observed which could pose a danger to children. There are no bodies of water on the premises.

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CALKINS, LAURA & MICHAEL
FACILITY NUMBER: 304313659
VISIT DATE: 05/04/2023
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The licensee does have a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. LPA observed 2 from 0-12 months. LPA observed and reviewed LIC 9227 Individual Infant Sleeping Plan in children’s files. However, there were no sleeping logs observed in the infants files. LPA gave licensee an example of a sleeping log that she can start using.

The licensee Pediatric CPR/First Aid certification expired 7/3/23. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, 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. Proof of immunization against pertussis, measles for licensee and licensee’s husband were reviewed and within compliance. and a written declaration to decline influenza was observed. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years.

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

The licensee understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian



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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CALKINS, LAURA & MICHAEL
FACILITY NUMBER: 304313659
VISIT DATE: 05/04/2023
NARRATIVE
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CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms.
The licensee was informed of the Important Updates available at www.ccld.ca.gov and may request to be added to an email list to receive Community Care Licensing Important Notifications from the above website and selecting Receive Important Updates link

A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:


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 licensee 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 if 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.

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CALKINS, LAURA & MICHAEL
FACILITY NUMBER: 304313659
VISIT DATE: 05/04/2023
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The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Infant Safe Sleep 102425(j)(2), Infant Safe Sleep 102425(j)(2)(D), and 102370(d) (see LIC 809D).

Due to the Type A violations cited today, the licensee shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

An exit interview was conducted with licensee Laura Calkins. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

End of Report.

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 05/04/2023 04:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: CALKINS, LAURA & MICHAEL
FACILITY NUMBER: 304313659

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(j)(2)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and file review, the licensee did not comply with the section cited above in 2 out of 2 infants did not have a sleep log in their file which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/05/2023
Plan of Correction
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When infants are sleeping Licensee will start checking every 15 minutes to check their position, skin color, breathing, level of sleep, and body temperature and will documented.
Type A
Section Cited
CCR
102425(j)(2)(D)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 out of 2 infants did not have a sleeping log and are not checked every 15 minutes which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/05/2023
Plan of Correction
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When infants are sleeping Licensee will start checking every 15 minutes on the infants to check their position, skin color, breathing, level of sleep, and body temperature and will documented.
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: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6


Document Has Been Signed on 05/04/2023 04:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: CALKINS, LAURA & MICHAEL
FACILITY NUMBER: 304313659

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type A
Section Cited
CCR
102370(d)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in Licesee's daughter Krista Calkins which resides at the home does not have a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/05/2023
Plan of Correction
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Licensee's daughter Krista Calkins will be in the upstairs home and will not come down during day care hours and will not interact with the day care chidlren. Licensee will provide the criminal clerance documentation to LPA by June 5, 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6