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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818001
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:19:53 PM


Document Has Been Signed on 09/08/2022 02:19 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:NELSON FAMILY CHILD CAREFACILITY NUMBER:
364818001
ADMINISTRATOR:NELSON, LILLIAN & EARLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 951-5002
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 2DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Earl and Lillian Nelson LicenseeTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPAs) Steven Montoya conducted an unannounced Required 1 Year inspection at the above facility. Upon arrival, the LPA met Earl and Lillian Nelson, who guided the LPA to tour of the Large Family Child Care home. Individuals that reside in the home include 2 adults (licensee, her husband). Per LIS, facility annual fees are current. All adults living in the home have been background cleared. Per licensee, the hours of operation are Monday through Sunday 4:00 a.m. to 3:00 a.m.

The Home is set up as follows:
This is a two story house with 4 bedrooms, 3 bathrooms, kitchen/dining room, family/daycare room, living room, and attached garage. Per Licensee the living room, and family room/kitchen, 1 bathroom are utilized for the family child care activity area. Per licensee off-limit areas of the home is the all bedrooms, master bathroom and upstair rooms. The home was inspected for safety, comfort, cleanliness, telephone service, central air and heat and ventilation.
Main Area: Main care will be conducted in the garage/playroom. There is a door located prevents children from accessing house. play room: In the Family room which is the designated playroom, LPA observed age-appropriate toys and furniture for the children. A small table was observed with a total of eight chairs. Several plastic storage bins were observed in which games and toys are stored for the children. There are games and books on the premises of this facility. There are mats on the floor that have educational/learning activities on them.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NELSON FAMILY CHILD CARE
FACILITY NUMBER: 364818001
VISIT DATE: 09/08/2022
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Family Room: In the family room a fireplace was observed that was properly screened via mirror glass doors. In the family room, there were additional toys observed to be in the room stored on cubbies.

Kitchen The kitchen was inspected to ensure hazardous and dangerous items were inaccessible to children (Safety latches). LPAs inspected the kitchen and observed that all lower cabinets and drawer have child proof latches that are in good condition.

Bathroom #1: Children utilize a bathroom that is in the hallway. Bathrooms were toured, and inspected sink/toilet are in operable condition. Toilet and faucets are clean, safe, and operable. All poison and medications are made inaccessible to children with child safety latches on the sink cabinet. There was one cabinet that was observed to have a child proof latch on it; hand soap was observed in the cabinet.

Backyard: The backyard was inspected; the backyard is dirt landscaping surrounded by vinyl fencing. Children have access to the backyard. LPA's observed, a plastic kid's slide, several fruit trees, a basketball hoop with other age appropriate toys. LPAs did not observe a swimming pool or bodies of water on the premises. LPAs also observed a big playhouse on the top the hill. According to Licensee’s husband, it is only for his own children. It is not for daycare child. Licensee will ensure that children are always supervised while outside in the backyard. There is no body of water on the premises.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NELSON FAMILY CHILD CARE
FACILITY NUMBER: 364818001
VISIT DATE: 09/08/2022
NARRATIVE
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Facility Roster: LPA observed Child Care Facility Roster. Per Licensing Information System, facility annual fees were current.
· Licensee has posted as required the Facility License, Emergency Disaster plan, and Parents Rights Poster. The facility roster is not current. there are no current facility earthquake/fire drills documents observed during the time of this inspection.

The following information was discussed with the licensee:


ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The licensee is reminded that 100% supervision is required for children at all
times.

Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.

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 The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: NELSON FAMILY CHILD CARE
FACILITY NUMBER: 364818001
VISIT DATE: 09/08/2022
NARRATIVE
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Fire extinguisher (2A10BC): LPA observed there is a required fire extinguisher (3A40BC) few years back and located in the kitchen inaccessible to children.

Smoke Detectors and Carbon Monoxide: The smoke detectors and carbon monoxide devices tested operable.

Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.

Bodies of water: There are no bodies of water in the home.

Medications and cleaning solutions are stored in locked cabinets in the off-limits area (Master Bedroom).

Weapons or Firearms: Per licensee, there are no weapons or firearms. LPA did not observe any weapons or firearms.

Incidental Medical Services (IMS): 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 will not be providing medication to children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: NELSON FAMILY CHILD CARE
FACILITY NUMBER: 364818001
VISIT DATE: 09/08/2022
NARRATIVE
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CPR/First Aid: LPA observed licensee has current Pediatric CPR and First Aid Training with expiration date (11/2022) 1 hour of nutrition training, (8) hours of Preventive Health and Safety Training.

Immunization: The licensee has the required immunization. The licensee provided a written statement declining the influenza vaccination.

Mandated Reporter Training: The licensee has not completed the online mandated reporter training at www.mandatedreporterca.com.

Transportation: The licensee does provide transportation for children. The licensee has a valid California driver's license with an expiration date of 12/12/2023. Licensee has valid vehicle insurance with the expiration date of 08/02/2022 and 2/02/2023 and vehicle registration dated 02/10/2023.

Fire Drill and Disaster Drill: Per the licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 06/03/2022 .

Safe Sleep: LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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 puased

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: NELSON FAMILY CHILD CARE
FACILITY NUMBER: 364818001
VISIT DATE: 09/08/2022
NARRATIVE
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Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day 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.

Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.


Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Licensee was reminded a LPA Duty Worker is available for questions at the Palmdale Regional Office: Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM.

LPA provided consultation during the inspection.

No Deficiencies cited: Licensee provided a technical advisor to comply with regulation for mandated reporting requirements.



Exit interview conducted and report was reviewed with the licensee
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 09/08/2022 02:19 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: NELSON FAMILY CHILD CARE
FACILITY NUMBER: 364818001

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
POC Due Date: 09/09/2022
Plan of Correction
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Licensee will complete Mandated reporting certificate by 9-9-2022.
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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7