364844496-7-8-2021-12-CC-LTMR-C4QSMV-20210708140034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364844496
Report Date: 07/08/2021
Date Signed: 07/08/2021 02:00:40 PM

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:	WALLACE FAMILY CHILD CARE		FACILITY NUMBER:	364844496
ADMINISTRATOR:	WALLACE, FALINCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 995-6329
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92394
CAPACITY:	14	CENSUS: 8	DATE:	07/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:24 PM
MET WITH:	Falincia Wallace		TIME COMPLETED:	02:15 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) Thompson-Miller met with Licensee Falincia Wallace who guided analyst on a tour of the facility for a One Year Required Inspection. This is a two story 4 bedroom, 4 bathroom home with kitchen/dining, family room, living room, formal dining room, laundry room, loft, office and garage. Upon arrival LPA observed 8 children (toddlers/preschool) eating lunch, assistant and licensee present. Days/Hours of operation are Monday through Friday, 6:00am to 5:30pm. There is no pool/spa or body of water on the premises. Family members residing in the home include 2 adults (licensee, licensee spouse) and no children. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Main care is provided in the living room, formal dining room and family room. Children use the bathroom on the left. Off limit areas include the entire upstairs (All Bedrooms #1 through #4, bathroom #2 through #4, laundry, loft), office, kitchen (gated) 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 room, locked closet in Bathroom #1), medicines (upstairs) and hazardous items (sharp knives upper kitchen cabinet) that can pose a danger to children. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. Stairs have a gate. Home is clean and orderly, fireplace is screened, latched and blocked with shelf/cabinet, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, operable Fire Extinguisher (2A10BC), no one smokes in the home. There is a designated area for ill child(ren) as necessary, no weapon/firearms, facility sketch complete and current, working telephone (cell and landline), poisons and cleaning items inaccessible to children. Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Kitchen is off limits (safety gate). Sharp items (knives), medication and chemicals located in upper cabinet and are inaccessible. Toilets and faucets are clean and operable and home has a clean fully stocked of food refrigerator/freezer.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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 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: WALLACE FAMILY CHILD CARE	FACILITY NUMBER: 364844496
	VISIT DATE: 07/08/2021

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
26
27
28
29
30
31
32

Outdoor: The backyard is completely fenced. There is a wooden swing/slide (anchored), Step 2 toys, separate gated area on the right side which is off limits, Air Conditioner unit is screened, shade and the plants area is inaccessible (gated). There are gates on the left and right side of the home. No pets. This play area is clear and clean of debris.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 07/31/2021. The electrical outlets are covered. Children nap on cots, there is cushioning material in the play area.
Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.
Documents Provided and or Discussed: The following were observed to be in regulation of Title 22 requirements: Seat Belt Safety, Safe Sleep poster observed, Notification of Parents' Rights.

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:

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; Regulation prohibits the smoking of any kind during the operation of the day care.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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: WALLACE FAMILY CHILD CARE	FACILITY NUMBER: 364844496
	VISIT DATE: 07/08/2021

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
26
27
28
29
30
31
32

Licensee 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. The 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.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

The On Duty Worker is available for questions at 661-202-3318 Monday through Friday 8am-5pm. LPA provided consultation during the inspection.

No deficiencies. Exit interview conducted and a copy of report was read and provided to Licensee, Falincia Wallace on this date.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3