376100140-11-21-2019-51-CC-GCUS-BJ63DA-20191121170912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100140
Report Date: 11/21/2019
Date Signed: 11/21/2019 05:09:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	KELLEY, SUSAN FAMILY CHILD CARE		FACILITY NUMBER:	376100140
ADMINISTRATOR:	SUSAN KELLEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 533-9134
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92078
CAPACITY:	14	CENSUS: 0	DATE:	11/21/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Susan Kelley		TIME COMPLETED:	05:15 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) Leilani Curtis conducted an announced pre-licensing inspection with applicant, Susan Kelley. At approximately 4:00 p.m. the applicant’s husband, William Kelley arrived at the facility. The purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3. This 4 bedroom, 3 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children.

Applicant owns the facility and has provided proof by grant deed. Applicant will use the following areas for child care: kitchen, dining area, living room, playroom/den, bedroom #1, bedroom #2, bathroom #1, bathroom #2, front porch and enclosed rear yard. Off limits areas include: entire upstairs, bedroom #3 and front side yard. Stairs are barricaded via a gate. Applicant will utilize enclosed rear yard for outdoor activities. There are no bodies of water observed during time of visit. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. All poisons, cleaners and hazardous items in the home are inaccessible to children through latches, locks, and/or placed up on high surfaces.

Children’s toys and play equipment are available. At the time of inspection the Applicant had a firearm (B.B. gun) that was improperly stored. The Applicant immediately removed the firearm from the premises and placed it in her vehicle to return to her son's home. The Applicant has completed the 8 hours of preventative health training. Pediatric CPR and First Aid certifications expire on 5/18/2021. Applicant has completed the Mandated Child Abuse Reporting-per AB1207. LPA reviewed certification and it is in compliance. Required documents are posted. A review of staff records on this date indicate that caregiver background checks are being conducted. Criminal record and child abuse clearance and/or exemptions are pending. The Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon his/her 18^th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and are in compliance for all personnel that will be providing care and supervision to children. Applicant is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KELLEY, SUSAN FAMILY CHILD CARE	FACILITY NUMBER: 376100140
	VISIT DATE: 11/21/2019

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

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 maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.

The New Provider Resource Packet was reviewed with the applicant including information on the following: SIDS, shaken baby, safe sleep concepts, effects of lead, insurance, child abuse reporting, community resources, children’s records/facility records/required postings, immunization's, unusual incident report, roster, car seat law, visual for ratio/capacity, prohibited items handout (walkers, exersaucers, jumpers and bouncy seats), fire/disaster drill log, and the YMCA Resource Center. The Applicant was also reminded that corporal punishment and smoking are not allowed in the day care. LPA discussed California Megan's Law and provided: www.meganslaw.ca.gov. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

Prior to licensure, the following must occur:
-All facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2