376623793-9-24-2020-20-CC-MHOD-BTRMF6-20200924093350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376623793
Report Date: 09/24/2020
Date Signed: 09/24/2020 09:34:25 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 CARE		FACILITY NUMBER:	376623793
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	09/24/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tiffanie Raven, Licensee		TIME COMPLETED:	09:40 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	Licensing Program Analyst (LPA) Michelle Hood made an unannounced tele-inspection for the purpose of an increase in capacity. LPA met with licensee remotely via the FaceTime video due the Covid-19. On 08/31/2020, a fire clearance was approved for 14 children. Licensee will use the following areas for child care: daycare room, kitchen, and hallway bathroom. Licensee will contact assigned LPA once backyard work is complete. Licensee will use near by park for outdoor activities. There must be direct supervision while at the park with children in care. he off limits are all made inaccessible via door knob covers, safety gates, and door locks. There are no bodies of water observed during time of inspection. There is a sufficient amount of age appropriate toys, games, and books available. The home was clean and orderly during inspection. The fire extinguisher is rated 2-A;10; BC, smoke alarm and carbon monoxide detector are operational. The is a working telephone in the home and all required forms are posted. Licensee stated that there are NO firearms or ammunition on the property. All adults living or working in the home have been fingerprint cleared and associated. LPA reviewed children's files and emergency drill log. Licensee will email LPA a copy of the facility roster. Last fire/disaster drill was conducted 06/08/2020. Pediatric CPR and First Aid certification expire 01/2021. Mandated Reporter certification expire 08/2022. LPA reviewed the following with licensee: SIDS, car seat law, reporting requirements, shaken baby syndrome and care and supervision. Licensee was also reminded the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care. 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.html

SUPERVISOR'S NAME: Joe Carrasco	TELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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 2

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: 09/24/2020

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
26
27
28
29
30
31
32

The maximum capacity for a large family child care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there is no Qualified Assistant, 14 years of age or present, the capacity reverts back to the requirements for a Small Family Child Care. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

The Licensee will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

A Regular Large Family Child Care Home license may be issued for 14 children upon final file review.

SUPERVISOR'S NAME: Joe Carrasco	TELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Michelle Hood	TELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2