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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619195
Report Date: 08/10/2022
Date Signed: 08/10/2022 01:36:50 PM


Document Has Been Signed on 08/10/2022 01:36 PM - It Cannot Be Edited

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:NICKELL, LISA FAMILY CHILD CAREFACILITY NUMBER:
376619195
ADMINISTRATOR:LISA NICKELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 316-0603
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:14CENSUS: 5DATE:
08/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lisa Nickell, LicenseeTIME COMPLETED:
01:36 PM
NARRATIVE
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On August 10, 2022, at 10:00 AM, Licensing Program Analyst (LPA) Marie Hernandez conducted an unannounced annual inspection with the Licensee, Lisa Nickell. The purpose of the inspection is to ensure that the home complies with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present during the inspection are five children with the Licensee. The Licensee stated she currently does not have an adult helper as she is currently operating as a small family childcare home. The operating hours are Monday through Thursday from 8:00 AM to 4:00 PM.

This is a one story three bedroom, two bath home that was toured and inspected to ensure the environment is safe for the care and supervision of children. The home has bodies of water in the backyard; a Jacuzzi, that is locked and a water fountain. They are made inaccessible to children via a lock and gate. LPA observed the bodies of water during the inspection. The following areas are used for childcare: dining room, living room, hallway bathroom, bedroom #1 and the backyard. The off-limits areas are bedroom #2, master bedroom #3 with attached bathroom, kitchen, laundry room, storage/pantry room, garage, water fountain and the Jacuzzi. They are made inaccessible to day care children through the use of locks and child safety gates. The Licensee is utilizing the backyard for outdoor activities of children. The Licensee stated it is understood that there must always be direct supervision while outdoors with the children. The Licensee stated there are no weapons or firearms in the home. The fire extinguisher, smoke detector and carbon monoxide detector meets the requirements and are operational. All poisons, cleaners, and hazardous items in the home are inaccessible to children through latches, locks, and/or placed on high surfaces. The children’s toys and play equipment are available. The required documents are posted. The Licensee has completed the Eight Hours of Preventative Health. Pediatric CPR and First Aid certification expires on 02/27/2023. The Mandated Reporter AB1207 training certification expired on 03/07/2021; it must be renewed every two years prior to expiration date. The immunization records as per SB792 are incompliance. The fire/disaster drills and roster have been maintained. The Licensee was advised that no changes should be made to the home without prior notice and/or approval from Licensing. The Licensee states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes. The prohibited devices were discussed and the Licensee stated it is understood.

SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2022
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: NICKELL, LISA FAMILY CHILD CARE
FACILITY NUMBER: 376619195
VISIT DATE: 08/10/2022
NARRATIVE
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The Licensee currently does not plan on providing IMS to clients. 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 the publication: Commonly Asked Questions about Family Child Care and the ADA, available at: http://www.ada.gov/childqanda.htm.

The Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed with Licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following deficiency was cited today. An exit interview was conducted and the report was reviewed with the Licensee, Lisa Nickell.

SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/10/2022 01:36 PM - It Cannot Be Edited

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: NICKELL, LISA FAMILY CHILD CARE
FACILITY NUMBER: 376619195

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. On 03/07/2021, the Licensee's mandated reporter training certification expired.
POC Due Date: 08/26/2022
Plan of Correction
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The Licensee will complete the online mandated reporter training (AB1207) by August 26, 2022 and will submit proof of training to the Licensing Office by August 26, 2022. The Licensee will renew the mandated reporter training every two years prior to expiration.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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