367700083-8-27-2019-12-CC-DMAX-BFG2FB-20190827172118

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700083
Report Date: 08/27/2019
Date Signed: 08/27/2019 05:21:28 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:	JOHNSON FAMILY CHILD CARE		FACILITY NUMBER:	367700083
ADMINISTRATOR:	JOHNSON, TAMMY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 810-0839
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	14	CENSUS: 0	DATE:	08/27/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	04:19 PM
MET WITH:	Tammy Johnson		TIME COMPLETED:	05:35 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's), Maddox and Montoya met with applicant, Tammy Johnson for the purpose of conducting and announced Annual/Random inspection. Present today were applicant and her spouse (Davon Johnson). This is a single story with 3 bedrooms, 2 bathrooms. Family members residing in the home include 2 adults (applicant, her spouse. All adults in the home have fingerprint clearances and exams for T.B. LPA verified applicant has required immunization's. **LPA observed, a disassembled above ground pool in a gate area in the backyard. Main area of care is conducted in the Living family room, backyard and one bathroom. Children will use the bathroom in hallway. Off limit areas include all bedrooms # 1-3, master bathroom and garage. The kitchen and bathroom were toured and inspected for proper storage. Chemicals, detergents, cleaning compounds are secure in the garage. Sharp pointed objects, all items were made inaccessible to children in the kitchen above the refrigerator. All unused electrical outlets are plugged and play equipment and toys are available. There are age appropriate toys. Age appropriate napping (mats, playpen) equipment. applicant is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility. The backyard is completely fenced. No pets. Large commercial Jungle gym with swing set attached. Jungle gym is secure to the ground, so it wont tip over.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 367700083
	VISIT DATE: 08/27/2019

NARRATIVE

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applicant has current CPR and First Aid training (exp 3-2021). Per applicant, there are no weapons or firearms of any kind on the premises. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devises were are present and in operable condition. applicant has maintained a current roster and has documented Emergency Disaster drills no less than twice a year.

· applicant can access forms on line at www.ccld.ca.gov . LPA observed all required forms posted; Regulation prohibits the smoking of tobacco in any licensed facility. LPA informed applicant/applicant of the Departments Child Care Advocate’s (CCA’s) that can forward Quarterly updates regarding Child Care Licensing’s’ Rules and Regulations. You may contact the Child Care Advocate Program directly: Phone number: (916) 654-1541
Email address: childcareadvocatesprogram@dss.ca.gov

The applicant 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.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 367700083
	VISIT DATE: 08/27/2019

NARRATIVE

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ssued applicant the following: SIDS information and Shaken Baby Syndrome pamphlet – For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

******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 o 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

**§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions. (a) (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. –

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 367700083
	VISIT DATE: 08/27/2019

NARRATIVE

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§1596.8662 (b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. mandatedreporterca.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 child care facility are aware of situations that present the greatest danger to children.

**Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family child care homes shall post during hours of operation. **Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty. In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report documenting the Type A citation and sign form LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to. Applicant is aware of required forms for children's files and forms that shall be posted after licensure.

The On Duty Worker is available for questions at 661-789-6944 Monday through Friday 8am-5pm. There were no violations of Title 22 Regulations noted. Exit Interview conducted a copy of this report is discussed and left at the facility.

Prior to Licensing Needed documents:
* Immunizations for Applicant and Spouse.
* Inform New Licenses facility number.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019

LIC809 (FAS) - (06/04)

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