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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624050
Report Date: 10/27/2022
Date Signed: 10/27/2022 05:01:08 PM


Document Has Been Signed on 10/27/2022 05:01 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:WONG, LUCILYN FAMILY CHILD CAREFACILITY NUMBER:
376624050
ADMINISTRATOR:LUCILYN WONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 368-4854
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:14CENSUS: 9DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Lucilyn Wong, LicenseeTIME COMPLETED:
05:00 PM
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On October 27, 2022, at 2:30 PM, Licensing Program Analyst (LPA) Marie Hernandez conducted an unannounced annual inspection with the Licensee, Lucilyn Wong. 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. There were nine children present during the inspection with the Licensee and her adult helper Alissa Scott. The operating hours are Monday through Friday from 7:00 AM to 5:00 PM.

The home was toured and inspected to ensure the environment is safe for the care and supervision of children. The home does not have any bodies of water as per LPA's inspection. The Licensee stated there are no weapons/ firearms in the home. The following areas are used for day care: Kitchen, dining room, living room, hallway bathroom, day care room, the enclosed backyard and front yard. The off limits areas are made inaccessible to day care children through the use of a locked door and child proof safety gates. The Licensee stated the backyard is currently not being used by the children. The Licensee stated it is understood that there must always be direct supervision while outdoors with the children. 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. The Licensee's Pediatric CPR and First Aid certification expires on 04/2023. The Licensee's Mandated Reporter AB1207 training certification expires on 07/13/2024 and the adult helper Alissa Scott's Mandated Reporter AB1207 certification expires on 06/10/2023. The AB1207 certification must be renewed every two years prior to expiration date. The immunization records as per SB792 are incompliance. The last fire/disaster drill was conducted on 10/27/2022. The roster has 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: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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: WONG, LUCILYN FAMILY CHILD CARE
FACILITY NUMBER: 376624050
VISIT DATE: 10/27/2022
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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 CDSS important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

An exit interview was conducted and the report along with the appeal rights were reviewed and provided to the Licensee, Lucilyn Wong.

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

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
LIC809 (FAS) - (06/04)
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