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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626352
Report Date: 06/19/2019
Date Signed: 06/19/2019 04:02:05 PM

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:RANDOLPH, CINDY FAMILY CHILD CAREFACILITY NUMBER:
376626352
ADMINISTRATOR:CINDY RANDOLPHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 208-9206
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:14CENSUS: 11DATE:
06/19/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Cindy RandolphTIME COMPLETED:
09:45 AM
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(THIS IS A DATA ENTRY OF A MANUALLY PREPARED REPORT. PLEASE SEE ORIGINAL REPORT FOR SIGNATURES).

An unannounced annual inspection was conducted today. Upon arrival, LPA observed 9 children present with the licensee, Cindy Randolph and her helper Kayla Burmeister. Two more children arrived shortly. Children were participating in various indoor activities. Children have access to the following areas: living room, dining, kitchen, covered patio, hallway bathroom and back fenced yard. The 3 bedrooms, one bathroom and the garage are off-limits to children. There are no bodies of water present within the premises. Mrs. Randolph stated that she does not maintain any weapons. Fire extinguisher, smoke detector and carbon monoxide detector are present in the home. The home is kept clean and orderly with sufficient ventilation for safety and comfort. Outdoor play areas are fenced. The home provides sufficient toys and play equipment for children's use. The licensee maintains a current children's roster (copy provided to LPA today). Mrs. Randolph and her helper are both CPR/First aid certified. Current certifications are on file. A handout was provided to Mrs. Randolph today on "Effects of Lead Exposure". Licensee shall provide a copy of this handout to all the daycare parents.
Facility has not exceeded the capacity specified on the license. Licensee resides in this home with her spouse, Aaron Randolph; Grandparents Arturo Arce & Lena Arce and mother Leticia Bosmenier. There are no new adults living or working in the home over the age of 18 years. All individuals subject to criminal record review have obtained criminal record clearance.
NO DEFICIENCY CITED TODAY.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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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