376100672-3-2-2021-51-CC-JREG-BYR3M2-20210302172138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100672
Report Date: 03/02/2021
Date Signed: 03/02/2021 05:22:35 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:	BURNS, CHERYL FAMILY CHILD CARE		FACILITY NUMBER:	376100672
ADMINISTRATOR:	CHERYL BURNS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 313-1285
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	14	CENSUS: 0	DATE:	03/02/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Applicant Cheryl Burns		TIME COMPLETED:	03:30 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	LPA, Joelle Redding, met with Applicant, Cheryl Burns, for the purpose of a Pre-Licensing inspection. Applicant has applied for a change of location on 2/19/2021. LPA toured the home. It is a four bedroom three bathroom home with two garages and a granny flat. All required forms were posted, including Covid-19 related posters and information. There is a working telephone on the premises. LPA did not note any hazardous items accessible to children. There are no bodies of water or weapons/firearms or ammunition in the home or on the property. The fire extinguisher size (2A10BC or larger) meets requirements and is fully charged, located on the wall in the pantry. The smoke detectors (located in the each child care room and the living areas ) and carbon monoxide detector (located on the wall above the thermostat) are operational. All adults living or working in the home have been fingerprint cleared and associated and immunization requirements have been met. Control of property was verified. Applicant will be using the following areas all areas of the home with the exception of the master bedroom and bathroom, laundry room, garages and granny flat. Off limits areas of the home have been made inaccessible with the use of latches. Outdoor play area is fully-fenced. There are three areas, separated by gates. There are several trees and plants in the front yard of the home. Applicant will ensure these plants are trimmed and safe for the children prior to use and supervision will be present at all times. Applicant was reminded of requirements for children’s records, child abuse reporting, unusual incident reporting, immunizations, criminal background clearance procedures and policies, posting requirements. SIDS, Shaken Baby Syndrome and Incidental Medical Services. Applicant was reminded that walkers, exersaucers, bouncy seats, jumpers, drop side cribs and napping portables are not to be used for day care. Garage use and smoking during in or around day care areas is prohibited. Covid-19 safety guidelines were reviewed and applicant was provided a self-assessment guide for completion and return.

SUPERVISOR'S NAME: Renesha Pack	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2021

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BURNS, CHERYL FAMILY CHILD CARE	FACILITY NUMBER: 376100672
	VISIT DATE: 03/02/2021

NARRATIVE

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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, an updated Plan of Operation that includes 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. No services are provided at this time.

Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for updated Licensing information.

LPA conducted this visit prior to receiving the fire clearance to avoid a break in care or the requirement of a waiver due to Covid 19. Applicant has an appointment with the Fire Inspector on Thursday, March 4th at 2 pm. No additional corrections are required. Upon receipt of the fire clearance, final file review and the receipt of the completed self-assessment guide, the change of location will be granted and a license sent for posting.

This report is being delivered via email, due to Covid-19 restrictions. Applicant's reply to this email is considered confirmation of receipt.

SUPERVISOR'S NAME: Renesha Pack	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2021

LIC809 (FAS) - (06/04)

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