364843210-7-15-2021-12-CC-DMAX-C4XLS4-20210715090004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364843210
Report Date: 07/12/2021
Date Signed: 07/15/2021 09:00:08 AM

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:	HOOPER FAMILY CHILD CARE		FACILITY NUMBER:	364843210
ADMINISTRATOR:	HOOPER, KIMBERLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 886-2394
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY:	14	CENSUS: 4	DATE:	07/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:13 PM
MET WITH:	Licensee, Kimberly Hooper		TIME COMPLETED:	03:34 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, Kimberly Hooper today for the purpose of conducting and unannounced Req/1 year inspection. Present today were licensee and 4 day care children. The home is a single story home with 3 bedrooms and 1 bathroom. All adults in the home, (licensee states she and husband only), have fingerprint clearances and exams for T.B. The family room, 1 bedroom, patio, backyard (fenced) and 1 bathroom are designated for child care. Home has wall heater and split unit for air. The kitchen and bathroom were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children. The outside play area was clear of chemicals and debris, the entire yard is fenced. ***The swing set has been removed from the backyard. There are 2 sheds located in the backyard that were locked during this inspection. All unused electrical outlets are plugged and play equipment and toys are available. Licensee is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility. Licensee has current CPR and First Aid training (exp 11/2021), mandated reporter training, and verification of current immunization's as required. Per licensee, there are no weapons or firearms of any kind on the premises. LPA observed a current roster, and documentation of emergency/disaster drills. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devise are in operable condition.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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: HOOPER FAMILY CHILD CARE	FACILITY NUMBER: 364843210
	VISIT DATE: 07/12/2021

NARRATIVE

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The licensee is reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

Licensee is urged visit the U.S. Consumer Product Safety Commission web page at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled

Licensee is reminded of the following:
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter
- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited

Exit interview conducted, no violations noted

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC809 (FAS) - (06/04)

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