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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623793
Report Date: 06/06/2019
Date Signed: 06/06/2019 11:28:16 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:RAVEN, TIFFANIE FAMILY CHILD CAREFACILITY NUMBER:
376623793
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
06/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Tiffanie RavenTIME COMPLETED:
11:50 AM
NARRATIVE
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Licensing Program Analysts (LPA), Samantha Salunga and Leilani Curtis made an unannounced Annual Random inspection and met with Licensee, Tiffanie Raven. There were 4 children in care, 1 who is an infant. Also present was Licensee's 17-year-old daughter and Licensee's children's father, Dantae Jackson. Facility was observed operating within ratio and capacity. LPA's conducted a tour of the home inside and outside per facility sketch. Licensee is using the following areas for day care: living room, play room, hallway bathroom, and kitchen/dining room. Off-limits areas include: all bedrooms and garage. Per Licensee, business hours are from Monday thru Friday, 6am-6pm.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Children’s toys and play equipment are available and observed free of hazards. There are no stairs in the home. There is a working telephone/email address. LPA's observed sharp knives located on the kitchen counter right of the sink and kitchen drawer located right of the oven. The kitchen is part of the child care area and there were four children present during time of inspection, all who are mobile. Fireplace is screened. Fire extinguisher and smoke detector are operational. Licensee states there are no firearms or other weapons in the home. Outdoor play area is fenced. Licensee was advised to provide direct supervision during outdoor play. There are no existing bodies of water present. Children records were reviewed for Emergency Information. There are no new adults living or working in the home over the age of 18 years. Licensee was reminded that any minor upon his/her 18th birthday must be fingerprinted within 30 days. All adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions. Pediatric CPR and First-Aid certificates are valid through June 2021. Licensee has completed the Mandated Child Abuse Reporting-per AB1207. LPA reviewed certification and is in compliance. Immunization records per SB792 was reviewed and in compliance.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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 4
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: RAVEN, TIFFANIE FAMILY CHILD CARE
FACILITY NUMBER: 376623793
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2019
Section Cited
CCR
102417(g)(9)(A)
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Operation of a Family Child Care Home. Each family child care home shall conduct fire drills and disaster drills at least once every six months. This was not met as evidenced by; Licensee failed to provide proof that she conducted a fire drill.
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LPA's provided Licensee with a copy of a fire drill log. Licensee posted the log near her license to refrain from losing it. Licensee states that she will conduct a fire drill with the day care children, today 06/06/19, and document it on the log.
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This poses a Potential Health and Safety risk to the clients in care.
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Licensee states that she will provide LPA Salunga a copy of the completed log via email by POC due date.
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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: RAVEN, TIFFANIE FAMILY CHILD CARE
FACILITY NUMBER: 376623793
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2019
Section Cited
CCR
102417(g)(4)
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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
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Licensee immediately removed the knives and placed them under the kitchen sink which is appropriately latched and inaccessible. Licensee states that she will purchase and install gates to make the kitchen off
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This was not met as evidenced by; LPA's observed sharp knives located on the kitchen counter right of the sink and kitchen drawer located right of the oven. The kitchen is part of the child care area and there were four children present, all who are mobile. This poses an Immediate Health and Safety risk to the clients in care.
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limits. Licensee states she will provide proof of correction LPA Salunga by POC due date.
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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: RAVEN, TIFFANIE FAMILY CHILD CARE
FACILITY NUMBER: 376623793
VISIT DATE: 06/06/2019
NARRATIVE
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LPA reviewed the following with Licensee: Safe Sleep Regulation Concept Handout, Car Seat Law, reporting requirements, regulation highlights, community resources, capacity limitations, supervision, clearances, emergency drills, mandated reporting, SIDS, and Shaken Baby Syndrome. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Licensee is aware that interference with a child’s daily functions, corporal punishment, physical and mental abuse is not allowed. Licensee is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

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

See LIC809D for cited deficiencies. The licensee was provided a copy of her appeal rights (LIC 9058 01/16) and her signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit. LPA's reviewed this report with Licensee prior to obtaining her signature. LPA's also reviewed and provided Licensee with LIC9102- Technical violation dated today, 06/06/2019.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov.
Duty Officer: (619) 767- 2248, Monday thru Friday 8am-5pm.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4