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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364802228
Report Date: 06/04/2024
Date Signed: 06/04/2024 04:49:36 PM

Document Has Been Signed on 06/04/2024 04:49 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:JOHNSON FAMILY DAY CAREFACILITY NUMBER:
364802228
ADMINISTRATOR/
DIRECTOR:		JOHNSON, DESA J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 701-9690
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
06/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Desa Johnson, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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 Licensing Program Analyst (LPA),Ibitoye met with Licensee, who granted access and guided analyst on a tour of the facility for an Annual Random inspection. This is a single story 5-bedroom, 3-bathroom home with kitchen/dining, living room, formal dining room, family room, laundry (washroom) room and garage. There are three adults (Licensee, Spouse and one adult son) and two children that reside in the home. Incidental Medical Services (IMS) policy was discussed. Upon arrival there were nine children in care and three assistants interacting with the children inside the daycare/outside play area. Transportation is provided. There is a working telephone (cell) .
Physical Plant: Main childcare is provided in a separate, constructed, 1200 sq ft. add on (in 2019-2021) area with two rooms, kitchenette, and bathroom with access to the main house (off limits) from the kitchenette. No stove, refrigerator/freezer (working). Children use the bathroom to the left of the kitchenette. It was inspected and is clean and in good repair. No poisons, shampoos, razors, or hazardous items or cleaning supplies. Knives/sharp objects in lock combination box on top of file cabinet (no access). There are no medications inside the daycare. Fire/earthquake drills complete(04/24/2024) and current. Roster complete and current. There is no pool/spa or body of water. Age-appropriate toys and books. Age-appropriate napping equipment (cots, playpen). The required fire extinguisher (2A10BC) and smoke detector and carbon monoxide detector are in operable condition. There is central heating and AC.

Off limit areas: Main house Bedrooms #1-#5, Bathrooms #1, #2, and #3, the living room, and the formal dining room, family room, laundry room, and garage.
Outside: Backyard is completely fenced. The rear and right section of the backyard is off limits. There is concreted area and sand for play, basketball court, tether ball pole, and sitting benches. The backyard houses 3 storage sheds (locked) and a shipping container (locked). AC unit in the yard covered. There is a service dog in the home per Licensee all the shot record are current.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JOHNSON FAMILY DAY CARE
FACILITY NUMBER: 364802228
VISIT DATE: 06/04/2024
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Per Licensee, there are no weapons or firearms on the premises.LPA did not observe any weapons/firearms. Postings were present, trainings were current. CPR/First Aid expires 01/23/2025. Mandated Reporter Expires(05/05/2025).The First Aid kit was observed and is complete. Staff and children’s files were reviewed.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The following was discussed with the Licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed, to be completed every two years; Licensee reminded that 100% supervision is required at all times to children in care; Licensee made aware that it is his/her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the daycare. Per the Licensee no one smokes in the home. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. Licensee advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.

The license advised of the requirement to report Unusual Incidents. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JOHNSON FAMILY DAY CARE
FACILITY NUMBER: 364802228
VISIT DATE: 06/04/2024
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The licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to part obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from the parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family childcare home or grounds, the Licensee shall notify the Department of the proposed change, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition, or construction.

The licensee 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, before 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations, also enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

LPA discussed the safe sleep regulations with the licensee and also instructed the Licensee to visit 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JOHNSON FAMILY DAY CARE
FACILITY NUMBER: 364802228
VISIT DATE: 06/04/2024
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 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms.

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.

Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Issued 1 Technical Advisory Note see LIC 9102. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 am-5 pm. An exit interview was conducted, and the report was reviewed with the Licensee Desa Johnson

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
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