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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843790
Report Date: 11/25/2019
Date Signed: 11/25/2019 04:20:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:BURRELL FAMILY CHILD CAREFACILITY NUMBER:
364843790
ADMINISTRATOR:BURRELL, TIERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 362-3565
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY:14CENSUS: 6DATE:
11/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:59 PM
MET WITH:Tierra Burrell Licensee TIME COMPLETED:
04:26 PM
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Licensing Program Analyst (LPA) Montoya met with Licensee, Tierra Burrell, who guided LPA to tour the Family Child Care Home (FCCH) for unannounced annual inspection. This is a single story 4 bedroom, 3 bathroom home with kitchen/dining, family room, living room, laundry room and garage. Family members residing in the home include 2 adults (licensee, licensee spouse) and three children. Days/Hours Monday through Friday, 6:00 AM to 7:00 PM.

Main care is provided in the living room (at entrance). Children use the bathroom in hallway on the Right. Off limit areas include all Bedrooms, bathroom #1 and #2, laundry and garage (key lock). The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (laundry), medicines (off limit bedroom) and hazardous items (sharp knives in upper kitchen cabinet) that can pose a danger to children. Fire/earthquake drills complete and maintained current. There is no pool/spa or body of water on the premises. Roster complete and maintained current. Incidental Medical Services (IMS) policy was discussed.

The backyard is completely fenced. There is no swing/slide. No pets.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: BURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364843790
VISIT DATE: 11/25/2019
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Per Licensee, there are no weapons or firearms on the premise. LPA did not observe any in the home. There are age appropriate toys. Age appropriate napping (cot, playpen) equipment. The required fire extinguisher (2A10BC) and smoke detector are in operable condition. The home has a Carbon Monoxide detector. Fireplace is screened. Home has central AC and heating. CPR/First Aid expire 02/09/2020. The First Aid kit was observed and is complete. Incidental Medical Services (IMS) policy was discussed.

The following was discussed with the Licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. Licensee advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Licensee advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: BURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364843790
VISIT DATE: 11/25/2019
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Requirements for fingerprint clearances and associations were discussed with the licensee.

Licensee advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).

Licensee informed to review Quarterly updates/regulations for 2015-2018 on the department website: Summer 2015 - Incidental Medical Services information.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: BURRELL FAMILY CHILD CARE
FACILITY NUMBER: 364843790
VISIT DATE: 11/25/2019
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--Licensee is advised visit www.shotsforschool.org for Immunization information.
--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640
--Family Child Care Providers (Disaster Planning information): https://ccld.family-child-care-providers/disaster-planning-and-fire-safety/
--Child Care Videos: https://ccld.childcarevideos.org
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Licensee advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.

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

LPA provided information to licensee about local CCRC days and times of operations.

No deficiencies. Exit interview conducted and a copy of report was read and provided to licensee on this date.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4