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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626991
Report Date: 12/15/2021
Date Signed: 12/15/2021 11:53:00 AM

Document Has Been Signed on 12/15/2021 11:53 AM - 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:HEADLEY, NORMA FAMILY CHILD CAREFACILITY NUMBER:
376626991
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Norma HeadleyTIME COMPLETED:
12:15 PM
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On 12/15/21 at 9:30 a.m., Licensing Program Analyst (LPA) Casey Gulley conducted an annual required inspection. Upon arrival, LPA met with Licensee Norma Headley and proceeded to tour the facility. There were two children in care. Facility is within ratio and capacity limitations. Child care operation hours are Monday through Friday from 7 a.m. to 7 p.m. LPA conducted a tour of the home/outdoor play area to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3.

Licensee has provided adequate space for the children to eat, sleep and play within the home. The home is kept is kept clean and orderly, with heating and ventilation for safety and comfort. Areas used for child care include: living room, kitchen, bedroom 4. Off limits areas of the home include: Master bedroom, bedroom 2 and kitchen. Off limit areas of the home are made securely inaccessible through use of door locks and gates.

All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. Children’s toys and play equipment are safe and age appropriate. Primary telephone is a cell which is operational. There are no firearms or other weapons in the home, per licensee. Licensee has all appropriate forms posted, per observation. Outdoor play area is fenced and free of hazardous items. LPA advised Licensee to provide direct supervision during outdoor activities. Children’s records and roster reviewed and complete. Pediatric CPR and First-Aid certificate are valid through 8/2022. There are no new adults living or working in the home. All adult residents and assistants have criminal record clearance/exemptions and child abuse index clearances. Last fire/earthquake drill was conducted on 06/2021. Licensee has met immunization requirement per SB792. In addition, Licensee have completed the AB1207 Mandated Reporter Training.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Casey Gulley
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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: HEADLEY, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 376626991
VISIT DATE: 12/15/2021
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LPA discussed the following with licensee: California Megan's Law, www.meganslaw.ca.gov. LPA informed licensee in order to access Child Care Licensing Regulations and Forms to visit the following website: http://ccld.ca.gov. LPA discussed the following with licensee: Child Care Advocates, (916) 654-1541, childcareadvocatesprogram@dss.ca.gov.

No deficiencies issued during today's visit. LPA conducted an exit interview with licensee. LPA discussed and provided the following to licensee: LIC809, LIC809-C, LIC9213-Notice of Site Visit and appeal rights. LPA informed licensee Notice of Site Visit must be posted for 30 days from today's date. LPA observed licensee post notice of site visit prior to exiting facility.

LPA discussed with licensee Community Care Licensing Duty Line: (619) 767-2248, open Monday through Friday from 8:00 a.m. to 5:00 p.m. LPA, Casey Gulley can be reached at (619) 767-2216 and at Casey.Gulley@dss.ca.gov.


To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, 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 [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Casey Gulley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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: HEADLEY, NORMA FAMILY CHILD CARE
FACILITY NUMBER: 376626991
VISIT DATE: 12/15/2021
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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.

Exit interview conducted and report was reviewed with the licensee Norma Headley.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Casey Gulley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
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