367700045-1-6-2022-12-CC-KZIS-CAESP5-20220106130234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700045
Report Date: 01/06/2022
Date Signed: 01/06/2022 01:03:08 PM

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:	HANEY FAMILY CHILD CARE		FACILITY NUMBER:	367700045
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	01/06/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Licensee, Cassandra Haney		TIME COMPLETED:	01:10 PM

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On 1/06/2022 Licensing Program Analyst (LPA) Zirbes, conducted a Case Management inspection with Licensee, Cassandra Haney. The purpose of the case management inspection was to assess the home for a capacity increase. and ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety and statutory requirement. The licensee is requesting to provide care for a Large family childcare home (FCCH) for the capacity of 14 children. At the time of this inspection, three preschool age children and the Licensee were present. Per licensee, residing in the home is licensee, addition adult, and three minor children
The home is described as follows:

This is an single story house with three bedrooms, two bathrooms, kitchen, dining room, living room, daycare room, attached garage, and backyard. Per Licensee the daycare room, living room, dining room, , kitchen, backyard and one bathroom are utilized for childcare activities. The off-limits areas consists of: three bedrooms, bathroom within the master bedroom, and the garage. These areas have been made inaccessible via the use of door locks. The home has a fireplace which was inaccessible at the time of this inspection via the use of a child safe lock on the glass screen. The home has central heating and air conditioning.

Indoor:

Living room: This area had three couches and a fireplace.
Dining room: This area was equipped with a table.
Daycare Room: This area had child size table and chairs, dramatic play area, and a chalk board. The room had various toys, blocks, art supplies, and additional learning materials for the child care children. Licensee expressed a willingness to purchase additional materials as necessary for the ages and stages of the children who will be enrolled into the program. All windows and screens are free of cracks, bugs and debris.
Report continued on page two

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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: HANEY FAMILY CHILD CARE	FACILITY NUMBER: 367700045
	VISIT DATE: 01/06/2022

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Kitchen: All sharp utensils and cutlery, drawers and cabinets with plastic bags, and sharp items or small things children can swallow; were made inaccessible to children with child safety locks. The sharps were stored in a plastic container on top of a cabinet in an area inaccessible to the children. The refrigerator, dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items. The Licensee prepares meals and snacks from the children in care.
Outside: The backyard had a covered patio and additional areas for the children to engage in gross motor activities. The Licensee had child size bikes, a little tikes slide and additional materials for the children.
Napping equipment (cots): LPA observed 9 cots. Per Licensee, the children will nap on cots in the living room area.
Electrical outlets: All unused electrical outlets are plugged in and made inaccessible to children.
Weapons or Firearms: Per the licensee, there are no weapons or firearms. LPA did not observe
any weapons or firearms.
Cleaning compounds are stored in the cabinet under the kitchen sink and on a high shelf in the laundry area. The cabinet door under the sink was equipped with a child safety lock.
The smoke detector and a carbon monoxide detector tested operable.
Fire extinguisher (2A10BC) There are three fully charged fire extinguisher (2A10BC); which meets fire marshal standards.
Pet: No pets in this facility
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.

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her 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

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare 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. Report continued on page three

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HANEY FAMILY CHILD CARE	FACILITY NUMBER: 367700045
	VISIT DATE: 01/06/2022

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·On January 1, 2018, or before March 30, 2018, a person who is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the online mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com

**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed childcare facility are aware of situations that present the greatest danger to children.

§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year

**Incidental medical Services (IMS) policy was discussed. Licensee will wait until facility opens to determine IMS needs. 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

·Safe Sleep in Child Care: Resources can be found on our website at http://www.cdss.ga.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep
·Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

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SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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

FACILITY NAME: HANEY FAMILY CHILD CARE	FACILITY NUMBER: 367700045
	VISIT DATE: 01/06/2022

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Licensee advised visit www.shotsforschool.org for Immunization information.

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.

As a result of this inspection, the home does meet Title 22 Regulations. The applicant is ready for the capacity increase and is pending manager's approval.

Exit interview conducted and report was reviewed with the Cassandra Haney

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

LIC809 (FAS) - (06/04)

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