376610537-10-11-2019-20-CC-BSYA-BGUNUX-20191011104703

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376610537
Report Date: 10/11/2019
Date Signed: 10/11/2019 10:47:15 AM

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:	JOHNSON, DOROTHY & SAMUEL		FACILITY NUMBER:	376610537
ADMINISTRATOR:	JOHNSON, DOROTHY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 264-1727
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92113
CAPACITY:	14	CENSUS: 5	DATE:	10/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Dorothy and Samual Johnson		TIME COMPLETED:	10:55 AM

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	On 10/11/19 at 9:20 a.m. Licensing Program Analysts (LPAs) Brooke Sykora and Dana Stevens made an unannounced visit for the purpose of a Random Annual inspection. At the time of the inspection, there were five children in care with the Licensees, two of which were under the age of two. Their adult helper, Samantha Dyson, was also present. The facility is within ratio and capacity. LPAs conducted a tour of the home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Hours of operation are Monday through Friday 7:00 a.m. to 6:00 p.m. Primary child care areas are the living room, bathroom, back patio room, and the fully fenced backyard. Off limit areas have been made inaccessible with the use of safety gates and door knob covers. There are no hazardous substances accessible. There are no weapons stored in the home or on the property and there are no bodies of water present. The facility utilizes a water table for outdoor sensory play and the Licensees were reminded to ensure it is emptied after each use. The fire extinguisher is full and of adequate size and located in the kitchen. The smoke detector, located in the front hallway, and carbon monoxide detector, located in the outside the bathroom, are operational. The home is clean, orderly and has adequate ventilation and heating. Licensees have provided sufficient space for the children to eat, sleep, and play within the home. Children’s toys and play equipment are safe and age appropriate. There is a working telephone and all required forms are posted. Children’s files were reviewed for emergency information. The last emergency drill was conducted on 09/03/19. The facility roster is current and complete. Licensees pediatric CPR/First Aid certificates are valid through 12/2020. Staff immunizations and Mandated Reporter Training requirements have been met. An out of state Mandated Reporter Training was completed by the present helper who was advised to complete the California child care provider training. SIDS/Safe Sleep was discussed and Safe Sleep handouts were provided. LPA and Licensees discussed California Megan's Law and LPA provided the following: www.meganslaw.ca.gov.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke Sykora	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: JOHNSON, DOROTHY & SAMUEL	FACILITY NUMBER: 376610537
	VISIT DATE: 10/11/2019

NARRATIVE

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Effect of Lead Exposure handout was provided and Licensees were advised to provide handout to parents/guardians of current and future enrollees.

The facility does not currently provide Incidental Medical Services. 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

Licensees were reminded that walkers, exersaucers, jumpers, and bouncy seats are not permitted for use. Licensees were advised to regularly visit the Community Care Licensing website: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information.

Southern California Child Care Advocate information was provided and Licensees were encouraged to subscribe to the email list on the CCLD website for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

No deficiencies were cited. An exit interview was conducted and a copy of this report was provided.

NOTICE OF SITE VISIT WAS POSTED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke Sykora	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

LIC809 (FAS) - (06/04)

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