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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629230
Report Date: 11/08/2021
Date Signed: 11/08/2021 01:11:54 PM

Document Has Been Signed on 11/08/2021 01:11 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:MAGNY, NANCY & CLARK, TERRANCE FAMILY CHILD CAREFACILITY NUMBER:
376629230
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/08/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Nancy Magny, LicenseeTIME COMPLETED:
01:25 PM
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On 11/08/2021 at 11:50 am, Licensing Program Analyst (LPA) Michelle Hood conducted an announced pre-licensing inspection for a change of location with licensee. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This 2 story 3-bedroom, 2 bath home was toured and inspected to ensure environment is safe for the care and supervision of children.

Licensee provided proof of control of property for review by the Department. Licensee will use the following areas for child care: living room, daycare room, downstairs bathroom, and backyard. Off limits areas include: garage, complete upstairs (3 bedrooms, 1 bathroom) and kitchen. They are made inaccessible to day care children through the use of door locks, doorknob covers, and safety gates. Licensee will utilize the backyard for outdoor activities, it is properly fenced. Home has safety gates blocking the stairs. There are bodies of water present in the home, a jacuzzi is located in the backyard, it's appropriately latched and inaccessible, LPA obtained photos of the bodies of water. The fire extinguisher is rated 2A 10B:C, smoke and carbon monoxide detectors meet requirements and are operational. All poisons, cleaners and hazardous items in the home are inaccessible to children through latches, locks, and/or placed up on high surfaces.

Children’s toys and play equipment are available. Licensee stated there are NO firearms or other weapons in the home. Licensee has completed the 8 hours of preventative health. Pediatric CPR and First Aid certifications expire on 12/05/2022. Required documents are posted. Licensee and all adults residing in the home have been cleared for criminal record and child abuse index clearances. Licensee was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon his/her 18th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and are in compliance for licensee. Licensees Mandated Reporter Training expires on 08/27/2022. Per licensee operating hours are 5:00 a.m. to 12:00 a.m.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2021
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: MAGNY, NANCY & CLARK, TERRANCE FAMILY CHILD CARE
FACILITY NUMBER: 376629230
VISIT DATE: 11/08/2021
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Licensee stated they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes.

Licensee does not provide 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The New Provider Resource Packet was reviewed with the licensee including information on the following: SIDS, safe sleep, LIC 9227, shaken baby, insurance, child abuse reporting, community resources, children’s records, facility records, required postings, immunization's, unusual incident report, roster, car seat law, visual for ratio/capacity, fire/disaster drill log, What to do if a child becomes sick or receives a new Covid-19 Diagnosis, Covid-19 FCC Quick Guides and CDPH Guidance for Use of Mask. Licensee was also informed 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.

The maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

A Regular Small Family Child Care Home license may be issued upon final file review.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC809 (FAS) - (06/04)
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