334844334-3-15-2022-10-CC-SBRR-CCJR8B-20220315124741

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334844334
Report Date: 03/15/2022
Date Signed: 03/15/2022 12:47:51 PM

Document Has Been Signed on 03/15/2022 12:47 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	JOHNSON FAMILY CHILD CARE		FACILITY NUMBER:	334844334
ADMINISTRATOR:	ANA JOHNSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 491-0197
CITY:	WINCHESTER	STATE: CA	ZIP CODE:	92596
CAPACITY:	14	CENSUS: 11	DATE:	03/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Licensee Ana Johnson		TIME COMPLETED:	12:55 PM

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On 03/15/2022 at 8:00 AM Licensing Program Analyst (LPA) Susan Brewer arrived unannounced at the facility to conduct an annual inspection. LPA was granted entry by Licensee Ana Johnson, conducted a COVID19 Pre-screening. The licensee granted the LPA entry to tour the facility inside and out. LPA conducted a census of 11 children in care, reviewed records, observed and discussed the following: Present was the LIcensee's Spouse/Qualified Assistant Wilson Johnson.

Normal days and hours of operation are: Mon- Fri 6:00 PM- 6:00 PM.

OFF-LIMIT AREAS INCLUDE: Garage, Entire 2nd Floor, Outdoor side yards.

· The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio, Capacity, and Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC9102TA x2. Deficiencies not cited this visit.

· The facility is operating within the licensed capacity and appropriate ratios on 03/15/2022.
· The Licensee is present in the home and has ensured that children in care are supervised.
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children
· A working telephone is present.
· Appropriate fire extinguisher verified, smoke detector and carbon monoxide detector are present and were tested by the Licensee during this inspection on 03/15/2022.
· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children
· Storage of poisons is inaccessible to children and locked
· There is a properly barricaded fire place

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 334844334
	VISIT DATE: 03/15/2022

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· Guns or weapons present as stated by the Wilson Johnson. At approximately 9:32 AM W. Johnson, lead LPA to inspect the storage of firearms and ammunition. LPA verified the storage of weapons were in compliance with Title 22 regulations. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Stairs are barricaded at this time.
· Home is clean and orderly, with heating and ventilation for safety and comfort
· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present
· Verification of control of property on Grant Deed on file.
· Pediatric CPR and First Aid 04/21/2021 Card expires on 04/2023
· Health & Safety Certificate - completed on 08/21/1999, Transcripts on file.
· Mandated reporter: General: Not on File; AB1207 Child Care Completed 03/16/2020, Expires: 03/2022
· Fire clearance: 03/01/2017
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 12/29/2021 at 9:00 AM with 6 children present, evacuated to the corner and lasted 34 minutes.
· There are bodies of water observed on 03/15/2022. The licensee has an in-ground pool which is surrounded by mesh fencing, 5 ft high and verified by LPA to have a self-latching gate in compliance with Title 22 regulations. 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
· Children’s files are NOT complete on 03/15/2022. LPA conducted a review of children's records and Child 9 (C9 on LIC857C), age 20 months did not have a sleep log or LIC627 Medical Consent form on file. C9 was not present.
· Staff Records are complete CPR/1^st Aid 04/25/2021 & Card expires on 04/2023, Mandated reporter: General not on file, AB1207 Child Care Completed 03/15/2020, Expires: 03/2022

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 334844334
	VISIT DATE: 03/15/2022

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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

Licensee Ana Johnson was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Ana Johnson.

Appeal rights discussed and a copy of this report was provided to the licensee on 03/15/2022

SUPERVISOR'S NAME: Pauline Beschorner	TELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

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