364819059-8-16-2022-12-CC-EROZ-CHCGXE-20220816054348

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364819059
Report Date: 08/15/2022
Date Signed: 08/16/2022 05:43:56 AM

Document Has Been Signed on 08/16/2022 05:43 AM - 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:	COUSE FAMILY CHILD CARE		FACILITY NUMBER:	364819059
ADMINISTRATOR:	COUSE, SARAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 843-5979
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92395
CAPACITY:	14	CENSUS: 10	DATE:	08/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:06 AM
MET WITH:	Sarah Couse		TIME COMPLETED:	12:40 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 08/15/2022, at 10:06 a.m. Licensing Program Analysts (LPA) Esequiel Rodriguez conducted an unannounced annual inspection at the Family Child Care Home to assess the Facility operation of their program and current physical plant status. Also, to evaluate the Facility's continuing ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements, and other applicable State and Licensing Statutory requirements. LPA Rodriguez met with Licensee, Sarah Couse and stated the reason for the inspection. The LPA provided a copy of the Entrance checklist form, LIC 126. LPA Rodriguez told provider that to better assure and promote the health and safety of each individual being cared for in licensed setting, the Community Care Licensing Division's (CCLD) is focusing efforts on three priority areas: Prevention, Compliance, and Enforcement; Therefore, CCLD launched the Inspection Process Project (IPP) to meet these goals. As a result it developed the Compliance and Regulatory Enforcement (CARE) Tools for the Child Care Program which is being used during today's inspection. These does not impose any new requirement on the provider. At 10:38 a.m. LPA Rodriguez along with the Licensee conducted a walk trough of the entire family child care facility. The Facility license is posted on a prominent place of the facility. The home is licensed to provide day care services to 14 children. All of the play yards or playpens used by the facility are made of material (mesh or fabric) that has not been banned or recalled by the United States Consumer Product Safety Commission. The home is clean, safe and orderly, with heating and ventilation for safety and comfort. The home maintain telephone service (Licensee was advised the cell phone shall be charged and available during day care hours.) The facility has safe age appropriate toys, play equipment and materials for the children care to use. There are no fixtures, furniture, and/or equipment that have been banned or recalled by the United States Consumer Product Safety Commission present or accessible to children at the facility at the time of this inspection.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COUSE FAMILY CHILD CARE	FACILITY NUMBER: 364819059
	VISIT DATE: 08/15/2022

NARRATIVE

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Per Licensee, if food is brought from the children's homes, the container is labeled with the child's name and properly stored or refrigerated.

The facility is free from defects or conditions which might endanger a child. The fireplace and open face heaters are properly screened to prevent access by children. The facility has an operational carbon monoxide detector and fire extinguisher which meet established standards. Stairs to second floor of the facility is properly fenced or barricaded. Poisons, detergents, cleaning compounds, medicines, firearms (no fire arms at this facility) and other items which could pose a danger if readily available to children are stored where they are locked and inaccessible to children. The facility has a written disaster plan of action prepared. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, have been instructed in their duties under the disaster plan. Newly enrolled children are informed promptly of their duties as required in the emergency plan. Fire drills and disaster drills are conducted at least once every six months and/or more often, the licensee document the drills, including the date and time of each drill. There are no baby walkers in the facility.

Smoking is prohibited on the premises of a family child care home. Currently, there are no infants in their program. However, Licensee is aware of new regulatory requirements regarding the safe sleep regulatory requirements. She knows that there must be one crib or play yard for each infant who is unable to climb out of the crib or play yard. The crib(s) or play yards use by the facility must meet the United States Consumer Product Safety Commission safety standards. Placement of crib(s or play yards shall not hinder entrance or exit to/and from the space where infants sleep. Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. The mattresses shall be made specifically for the size crib or play yard in which they are placed.

The LPA explained Licensee how to obtain additional child care information by visiting Community Care Licensing (CCL) Web Applications (www.ccld.ca.gov). The LPA provided advise on how to obtain Providers Information Pins and CCL Quarterly Updates; Child Abuse Mandated Reporter Training (www.mandatedreporca.com); Lead Safety Information; Personnel/Assistant Requirements; Safe Sleep; Incidental Medical Services (IMS) Reporting Requirements; Guardian program, and other CCL requirements.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COUSE FAMILY CHILD CARE	FACILITY NUMBER: 364819059
	VISIT DATE: 08/15/2022

NARRATIVE

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The Facility does not have any bodies of water. The outdoor play areas are properly fenced and supervised by the licensee.

Per Licensee, she is present in the home during child care time and ensure all children in care are supervised at all times. When circumstances requires her to be temporarily absent from the home, she arranges for a substitute adult to care for and supervise the children during her absence. Per Licensee, her temporary absences does not exceed 20 percent of the hours that the facility is providing care per day. Licensee states that when a child shows signs of illness he/she shall be separated from other children, and the nature of the illness is determined. If it is a communicable disease he/she shall be separated from other children until the infectious stage is over.

The licensee has completed or renewed their mandated reporter training and is current with required immunization or exemptions from immunization. The licensee has completed training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid. Records Licensee and assistant have been immunized against influenza, pertussis, and measles. Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or within 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report unusual incident/injuries report can also be mailed to unusualIncidentreport@dss.ca.gov

Personnel records are maintained on Licensee and each assistant and contain the following information:
Licensee and staff full name. A signed and dated copy of the Notice of Employee Rights [LIC 9052,] A signed statement regarding their criminal record history, LIC 508. Driver's license number if the employee is to transport children. Date of employment. Date of birth. Current home address and phone number. Documentation of completion of training on preventative health practices as required by Section 102416(c). All personnel records are maintained at the facility. Any change to the facility from an area of the family child care home previously. Licensee and assistant(s) have been immunized against influenza, pertussis, and measles. Licensee and other adults living in the home or working at the facility have received criminal record clearance and association. There is an emergency information card maintained for each child in care, completed and up to date.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: COUSE FAMILY CHILD CARE	FACILITY NUMBER: 364819059
	VISIT DATE: 08/15/2022

NARRATIVE

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The Licensee and other persons associated to the facility have obtained appropriate clearance or a criminal record exemption as required by the Department.

Per Licensee, each child receiving services at the Facility are treated with dignity and respect. They are
provided with safe, healthful, and comfortable accommodations, furnishings, and equipment. There is no corporal or unusual punishment of any kind, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

LPA encouraged licensee to become familiar with the CARE Tools and inspection processes by periodically visiting the Inspection Process Project and CARE Tools Website. The page will be updated regularly with information related to the new tools and related documents:
https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Regarding COVID-19, the LPA advised the Licensee that they should continue to follow COVID-19 requirements and guidance in all applicable CDSS Providers Information Notices (PINs) and All County Information Notices (ACINs), in addition to guidance or instructions from health care providers, Centers for Disease Control and Prevention (CDC), CDPH, Department of Developmental Services (DDS), Cal/OSHA, and local public health departments, as applicable to the particular facility or home category. If there are differing requirements between the most current CDC, CDPH, CDSS, DDS, Cal/OSHA, and local health department guidance or health orders, licensees and providers should follow the strictest requirements.

Overall, the Facility is in compliance per Title 22 regulations. During today's inspection the LPA observed no deficiencies that may hinder the health and safety of the children in care. No deficiencies cited during inspection. An exit Interview was conducted and a discussion of observations and this report was conducted. View points were discussed.

A copy of this Report, Review of Staff Records form (LIC 859) and Notice of Site Visit (LIC 9213) were provided to Licensee, Sarah Couse.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

LIC809 (FAS) - (06/04)

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