364820790-11-30-2022-12-CC-DMAX-CLNT28-20221130132018

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364820790
Report Date: 11/30/2022
Date Signed: 11/30/2022 01:20:34 PM

Document Has Been Signed on 11/30/2022 01:20 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MCBATH FAMILY CHILD CARE		FACILITY NUMBER:	364820790
ADMINISTRATOR:	MCBATH, TYWANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 887-3257
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY:	14	CENSUS: 3	DATE:	11/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:41 AM
MET WITH:	Tywana McBath		TIME COMPLETED:	01:32 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), Maddox met with licensee, Tywana McBath today for the purpose of conducting and unannounced Annual/Random inspection. The licensee guided analyst on a tour of the facility inside and outside. Present today were licensee, 3 day care children. The is a is a single story home with with 6 bedrooms and 3 bathrooms. There is a separate residence in the backyard that is occupied by licensee's son: 2790 Duffy St. #B. San Bernardino, CA 92407. **There are no pools, spas or any other bodies of water on the premises. All adults in the home (licensee and husband only) have fingerprint clearances and exams for T.B. Licensee utilizes the living room; 1 bedroom; 1 room addition located off the living room; enclosed patio; backyard; and 2 bathrooms (1 located inside of the room addition and the 2nd bathroom is located near the entrance of the home). Hours of Operation: 6:00 am to 7:00 pm Physical Plant: Home is clean and orderly, fireplace is inaccessible, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, operable Fire Extinguisher (2A10BC), Licensee is aware there is no smoking in the home. There is a designated area for ill child(ren) as necessary, there are/are no weapon/firearms, off-limit areas are identified as the office, 3 bedrooms, 1 bathroom located in the master bathroom, and storage room. There is a working telephone on the premises. Cleaning compounds inaccessible to children (located on top of the refrigerator and in the laundry room). Medicines are inaccessible to children (located in master bedroom). Licensee does not care for Infants.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022

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

FACILITY NAME: MCBATH FAMILY CHILD CARE	FACILITY NUMBER: 364820790
	VISIT DATE: 11/30/2022

NARRATIVE

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Kitchen: The kitchen is toured and there are no hazardous items accessible to children (child latch in place on cabinet), Sharp knives are kept up high in a container in a high cabinet.

Bathroom: The following are inaccessible - air freshener, razor blades, soap, mouthwash, shampoo, razor, nail polish. Toilets and faucets are clean, safe and operable. Bathtub and shower are free of hazards. Toilet paper and paper towels are present.

Outdoor: The outdoor play shall be supervised by the licensee particularity since the fencing that was previously in place is no longer present. There is also a trampoline present in the extreme rear of the yard (next to rear address) that is off limits to day care children. There is an area located on the side of the home that has tools. shed, and other miscellaneous items that could pose a hazard to children, this area is fenced off and off limits to day care children (Licensee shall ensure the gate into this area remains locked while day care children are present). There is a climbing structure with artificial grass underneath.

First Aid kit was observed with supplies readily available. CPR/First Aid expires 4/2023. Mandated Reporter completed on 10/28/2022; There is a current roster, all he electrical outlets are covered. Children nap on cots in the room addition (located off the living room. There are no hanging window blinds cords accessible to children.

Licensee provides transportation, LPA verified current CDL and Insurance coverage, and appropriate car seats.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022

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

FACILITY NAME: MCBATH FAMILY CHILD CARE	FACILITY NUMBER: 364820790
	VISIT DATE: 11/30/2022

NARRATIVE

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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, prior to 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.

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 following was discussed with the Licensee/Applicant:

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 were reviewed; Licensee were reminded that 100% supervision is required at all times to children in care; Licensee were made aware that it is 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;

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022

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

FACILITY NAME: MCBATH FAMILY CHILD CARE	FACILITY NUMBER: 364820790
	VISIT DATE: 11/30/2022

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Licensee/Applicant was advised of the requirement to report Unusual Incidents. 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 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. Licensee/Applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 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 parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from 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.

Exit Interview conducted, a copy of this report was discussed and left at the facility. Updated facility sketch.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022

LIC809 (FAS) - (06/04)

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