364820249-6-14-2021-12-CC-LTMR-C3YNBY-20210614101955

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364820249
Report Date: 06/14/2021
Date Signed: 06/14/2021 10:20:05 AM

COMPREHENSIVE INSPECTION

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:	SHIPMAN FAMILY CHILD CARE		FACILITY NUMBER:	364820249
ADMINISTRATOR:	JACQUELINE SHIPMAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 949-8394
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	14	CENSUS: 8	DATE:	06/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Jacqueline Shipman		TIME COMPLETED:	10:35 AM

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) Thompson-Miller met with Licensee, Jacqueline Shipman, who guided analyst on a tour of the facility for an 1 Year Required Inspection. This is a single story 3 bedroom, 2 bathroom home with kitchen/dining, family room, formal living room, laundry, office and garage (office, storage, laundry room area). There is a fountain (no water) and BBQ (locked) on the premises in the backyard. Hours of operation are 4:00 am to 11:00 pm, Monday through Sunday. Present during inspection were licensee, license spouse and eight daycare children (four school age,four preschool). Family members residing in the home include 2 adults (licensee, liceneespouse) and no children. Incidental Medical Services (IMS) policy was discussed. Physical Plant: The home is clean and orderly. The home entrance is through the front door. Main day care will be provided in the family room and office (next to the kitchen and laundry room). Children sleep in bedroom #1 and #2. Children nap on cots. Licensee is made aware that napping children are to be supervised. Children use the bathroom in hallway on the right. Off limit areas include the Bedroom #3 and bathroom #2. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (garage/laundry area), medicines (garage in locked cabinet). Fire/earthquake drills complete and maintained current. Roster complete and maintained current. There is a designated area for ill children as necessary in the family room. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. There are no weapon/firearms in the home. The facility sketch is complete and current, there is a working telephone (land line and cell).

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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: SHIPMAN FAMILY CHILD CARE	FACILITY NUMBER: 364820249
	VISIT DATE: 06/14/2021

NARRATIVE

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Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean an operable and home has a refrigerator/freezer clean. No chemicals in the kitchen were observed to be accessible. Breakfast, lunch, snacks and dinner will be provided. Hazardous items (sharp knives above the stove) that can pose a danger to children are inaccessible. Cabinets in the kitchen have magnet locks.

Outdoor: The play area is clear and clean of debris, play area is fenced and gated all around, no body of water on the premises.
The backyard is completely fenced. There is a jungle gym (wooden) that is anchored. There is one small dog (stay on the left side gated area), barbecue grill locked. There is a fountain (no water, rocks). Licensee reminded to supervise children while in the backyard. There is a rear section of the backyard that is gated and off limits to children.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 04/30/2023. Lead Poison flyer was provided to Licensee.

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

Documents Provided and or Discussed: LPA observed the following: COVID-19 posters, Lead Flyer, Safe Sleep, Seat Belt Safety

All adults living/residing in the home are fingerprint cleared and associated.

No deficiencies. Exit interview conducted and a copy of this report was read and provided to Licensee, Jacqueline Shipman.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

LIC809 (FAS) - (06/04)

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