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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843210
Report Date: 08/01/2022
Date Signed: 08/04/2022 09:50:33 AM


Document Has Been Signed on 08/04/2022 09:50 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:HOOPER FAMILY CHILD CAREFACILITY NUMBER:
364843210
ADMINISTRATOR:HOOPER, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 886-2394
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:14CENSUS: 3DATE:
08/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Kimberly Hooper, LicenseeTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA), Maddox met with licensee, Kimberly Hooper today for the purpose of conducting and unannounced Annual inspection. Present today were licensee, Spouse, 3 day care children, l grandchild. The home is a single story home with 3 bedrooms and 1 bathroom. All adults in the home, (licensee states she and husband are the only adults in the home), have fingerprint clearances and exams for T.B. The family room; 1 bedroom; patio; backyard, and bathroom are designated for child care. All areas were toured and found to be free of any health and safety hazards.

Home has central heating and air conditioning. 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. 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 and in good repair. Licensee is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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: HOOPER FAMILY CHILD CARE
FACILITY NUMBER: 364843210
VISIT DATE: 08/01/2022
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 Licensee has current CPR and First Aid training (exp 6/2024) and Mandated Reporter Training (exp 6/15/2024). Per licensee, there are no weapons or firearms of any kind on the premises. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devise are present and operable.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Licensee has a current Roster and documentation of Emergency/Disaster drills.



Licensee is reminded of the following:
  • Forms can access be accessed at www.ccld.ca.gov .
  • 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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 08/01/2022
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Licensee states she is aware of the updated Safe Sleep Regulations (1 infant in care today, Licensee has completed the 15 min checks while Infant was asleep).

LPA observed all required forms posted; Regulation prohibits the smoking of tobacco in any licensed facility.

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

PRIOR to any adult moving into the home or prior to employment of any adult, licensee must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

An exit interview was conducted and a copy of this report was provided to the applicant on this date.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
LIC809 (FAS) - (06/04)
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