334843745-6-2-2021-10-CC-OCAN-C3LL48-20210602082508

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334843745
Report Date: 05/26/2021
Date Signed: 06/02/2021 08:26:23 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	MANSELL FAMILY CHILD CARE		FACILITY NUMBER:	334843745
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	05/26/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Amani Mansell-Licensee		TIME COMPLETED:	01:41 PM

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	On 05/26/2021 at 1:45 PM Licensing Program Analyst (LPA), Otsanya Cameron, made and unannounced phone call to the facility for the purpose of conducting a Case Management Inspection. The licensee has applied to increase their capacity up to 14. LPA conducted a virtual tour of the facility inside and out, records were reviewed and the following was observed and discussed: The days and hours of operation will be: Monday to Sunday, 1:00 AM to 12:00 AM. OFF-LIMIT AREAS INCLUDE: GARAGE, LIVING ROOM, COMPLETE UPSTAIRS, BATHROOM, LAUNDRY ROOM, AND DOWNSTAIRS BEDROOM, LEFT & RIGHT REAR SIDE YARDS. · Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by the licensee during this inspection on 05/26/2021. The Cal-Fire Riverside Co. Fire Department granted clearance on 05/16/2021. · All hazardous items inaccessible on 05/26/2021 · Toxins locked · No guns or weapons present as of this 05/26/2021. LICENSEE UNDERSTANDS ALL GUNS, WEAPONS AND AMMUNITION MUST BE KEY-LOCKED SEPARATELY AND MADE INACCESSIBLE PER TITLE 22 REGULATIONS. · Stairs are barricaded on 5/26/21 · Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted · Pediatric CPR and First Aid Card expire on 09/22 · Health & Safety Certificate - completed on 1/10/16. Component for nutrition and Lead poisoning has not been updated, However, licensee states will submit proof of update to the department. · Mandated reporter Certificate expires 11/17/22

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya Cameron	TELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MANSELL FAMILY CHILD CARE	FACILITY NUMBER: 334843745
	VISIT DATE: 05/26/2021

NARRATIVE

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· There are no bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Clean, safe and age appropriate toys
· Documentation of fire drills on file . Last conducted 1/16/21
· Each child’s file contains a copy of the emergency information card with required information. LPA observed on this date, one child's LIC700 form was incomplete. Licensee states will have parent sign at pick up.
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. This was verified on 5/20/21
· 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 application for a LARGE Family Child Care Home will be submitted for approval with a maximum capacity of 12, or 14 with parent notification. An exit interview was conducted and a copy of this report was provided via email to the licensee on this date.

Due to the COVID-19 State of Emergency, this report was completed via Tele-Inspections Report Delivery Instructions. Licensee's signature will be obtained via email read receipt.. Licensee will receive a copy of this report via email. This report must be made available to the public upon request for the next 3 years

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya Cameron	TELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

LIC809 (FAS) - (06/04)

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