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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629230
Report Date: 12/06/2021
Date Signed: 12/06/2021 01:19:29 PM

Document Has Been Signed on 12/06/2021 01:19 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 FAMILY CHILD CAREFACILITY NUMBER:
376629230
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Nancy Magny, LicenseeTIME COMPLETED:
01:30 PM
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On 12/06/2021, at 12:25 pm, Licensing Program Analyst (LPA), Michelle Hood conducted an unannounced case management inspection with licensee, Nancy Magny. LPA notified licensee the purpose of the inspection was for a change of capacity and the licensee led LPA on a tour of the facility. There was one (1) child at the facility during the time of the inspection.

On 11/18/2021, a fire clearance was approved for 14 children. Licensee will use the following areas for child care: living room, daycare room, kitchen (safety gate), downstairs bathroom, and backyard. The off limits are all made inaccessible via safety gates and door knob covers. Licensee will utilize the backyard for outdoor activities, it is properly fenced. There is a safety gate 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. 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 four children's files and emergency drill log. LPA obtained a picture of the children's roster. Pediatric CPR and First Aid certification expire 12/05/2022. LPA discussed with Licensee maintaining supervision of day children at all times. 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. Licensee does not provide Incidental Medical Services (IMS) at this time.

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.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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 FAMILY CHILD CARE
FACILITY NUMBER: 376629230
VISIT DATE: 12/06/2021
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A copy of the licensing report, Notice of Site Visit – LIC 9213 and appeal rights (LIC 9058) was provided to the licensee. 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. An exit interview was conducted with the licensee.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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