376611214-8-16-2021-20-CC-RGOU-C5XPUQ-20210816113755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376611214
Report Date: 08/16/2021
Date Signed: 08/16/2021 11:38:02 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:	MAXWELL, REBECCA & DANIEL FAMILY CHILD CARE		FACILITY NUMBER:	376611214
ADMINISTRATOR:	MAXWELL, REBECCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 419-9219
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	14	CENSUS: 4	DATE:	08/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	Rebecca Maxwell		TIME COMPLETED:	11:45 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 08/16/21, at 10:12 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced Annual Inspection and met with co-licensee, Rebecca Maxwell. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. There were four children in care (school age children). This facility is a one story, five- bedroom, two bathroom house. The following areas are used for childcare: living room, kitchen, master bedroom, bedroom #2, bathroom located in bedroom #2, bathroom located in the hallway of home and front yard. The following off-limit areas are made securely inaccessible: garage, backyard, bedroom's #1, #3, #4. Operation hours are Monday to Friday from 6:00 a.m. to 6:00 p.m. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements, per LPA observation. LPA observed hazardous items inaccessible to children in care. LPA informed licensee poisons shall be placed in a storage area and locked. LPA observed toys, play equipment and materials available for the children’s use. The front yard is used for outdoor play. LPA informed licensee children shall be supervised during outdoor activities. LPA did not observe any bodies of water on the premises during the inspection. In addition, licensee confirmed there are no bodies of water on the premises of the property. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications are valid and expire on 11/30/21. Licensee's have required immunization's, per file review. LPA informed licensee the Mandated Reporter training shall be completed once every two years. The facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 06/01/21. See LIC809-C continuation page...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

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: MAXWELL, REBECCA & DANIEL FAMILY CHILD CARE	FACILITY NUMBER: 376611214
	VISIT DATE: 08/16/2021

NARRATIVE

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LPA informed licensee there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards shall be free from all loose articles and objects. Every infant 24 months and younger shall be checked on every 15 months and documentation shall be maintained in the infants file and shall include the following: Date, Time, and Infants name. In addition, the Individual Infant Sleeping Plan [LIC 9227 (3/20)] was discussed.

Non-Compliance Plan currently in place dated June 23, 2020.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regardingSafe Sleep Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

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.

No deficiencies issued during today's visit. LPA conducted an exit interview with licensee. LPA discussed and provided the following to licensee: LIC809, LIC809-C, LIC9213-Notice of Site Visit and appeal rights. LPA informed licensee Notice of Site Visit shall be posted for 30 days from today's date.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

LIC809 (FAS) - (06/04)

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