364815803-1-6-2020-12-CC-JNEL-BKKVW4-20200106154718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364815803
Report Date: 01/06/2020
Date Signed: 01/06/2020 03:47:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	BROWN FAMILY CHILD CARE		FACILITY NUMBER:	364815803
ADMINISTRATOR:	BROWN, MAYRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 245-6023
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	14	CENSUS: 8	DATE:	01/06/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Mayra Brown		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Neal met with licensee, Mayra Brown for the purpose of an Annual/Random inspection. This is a two story 5 bedroom, 4 bathroom home with kitchen, living room, formal dining room, laundry room, family room, and child care room (converted garage). There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 3 adults (licensee, her husband). Licensee, licensee's husband, licensee's assistant and 8 child care children were present during the inspection. Incidental Medical Services (IMS) were discussed. Parents enter child care through the side gate. Main care is provided in the converted garage. The downstairs bedroom (infant room) and living/dining room are used for napping children. Cots were observed. There are cribs, a changing table and a sink in the downstairs bedroom. Children use the bathroom located down the hall from the main entrance to the child care room. Children have access to the backyard. Off limit areas include the home's entire gated upstairs (4 bedrooms, 3 bathrooms) and the laundry room (key locked). Fireplace is screened. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds (in locked laundry room), medicines, and hazardous items that can pose a danger to children. Medicines and sharp knives are stored in the locked pantry. Facility roster is complete and maintained current. Fire/earthquake drills are also current. A sample of staff and children's records were reviewed.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: BROWN FAMILY CHILD CARE	FACILITY NUMBER: 364815803
	VISIT DATE: 01/06/2020

NARRATIVE

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There are small play structures with wood chips underneath and other play equipment in good condition. There are sandboxes as well as grass area, concrete area, and an area with a padded surface for active play. Licensee has 2 small dogs. There is a locked shed in the backyard where the garden tools are kept.
Per licensee, there are no weapons or firearms of any kind in the facility. The LPA did not observe any weapons. LPA observed age appropriate toys and napping equipment on the premises. The required fire extinguisher (2A10BC), smoke detector and carbon monoxide detector are in operable condition. Home has central AC and heat. Licensee's CPR/First Aid expires 9/9/2020 and assistant's expires 3/2021. LPA has a First Aid kit. Required documents are posted. Mandated Reporter training has been completed 2/19/2018; assistant's completed 12/5/2019. Licensee was reminded Mandated Reporter training for Child Care must be completed every 2 years for licensees and any adult assisting at the day care.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in 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 tobacco in a private residence that is licensed as a family child care home and in those areas of the family child care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: BROWN FAMILY CHILD CARE	FACILITY NUMBER: 364815803
	VISIT DATE: 01/06/2020

NARRATIVE

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Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12 month period, PER PERSON.

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

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. Handout on Safe Sleep Concepts was given and discussed.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

No deficiencies were cited during this inspection.
Exit interview was conducted, report was read and a copy was provided to the Licensee on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

LIC809 (FAS) - (06/04)

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