401709271-8-20-2021-17-CC-MKST-C63SD6-20210820134638

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401709271
Report Date: 08/20/2021
Date Signed: 08/20/2021 01:46:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	JORDAN FAMILY CHILD CARE		FACILITY NUMBER:	401709271
ADMINISTRATOR:	JORDAN, NATALIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 466-4244
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	14	CENSUS: 10	DATE:	08/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:56 AM
MET WITH:	Natalie Jordan		TIME COMPLETED:	01:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/20/21 at 11:56am, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 with Licensee, Natalie Jordan. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee and Assistant wore face coverings. Licensee reported that children over 2 years are not wearing face coverings. LPA explained that California Department of Public Health is requiring children over two (2) years to wear face coverings while indoors of child care settings and that Licensee can request the assistance of the children's parents to meet this requirement by encouraging children to wear face coverings while indoors of the Family Child Care Home. LPA observed the required documents posted inside of the home on the wall adjacent to the front door. There were 10 children including two (2) infants. LPA observed a Fisher Price Rock with Me Bassinet in the living room. Licensee reported that the 5 month old infant (C1) sleeps in the bassinet and that she has a portable crib, but has been using the bassinet as it is smaller and takes up less space in the living room. After discussing safety risks of a bassinet which an infant could fall out of when they begin to pull up, Licensee removed the bassinet and replaced it with the portable crib. Child care services are provided outside in the fully fenced yard and indoors in the living room and classroom in the back of the home near the restroom. LPA observed age appropriate toys, books and activities in the classroom. There is fireplace in the living room which is barricaded by a child safety gate. There are three (3) bedrooms near the bathroom used by children and the classroom. Licensee reported that the bedrooms are off limits and doors are kept closed, but not locked. Licensee stated that she will install hook latches at the top of each bedroom door to make the bedrooms inaccessible to children in care. was previously being used for day care, but is currently off limits and is kept locked while children are present. The bathroom used by children was observed to be clean and free of toxins and other items which could pose a danger to children. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: JORDAN FAMILY CHILD CARE	FACILITY NUMBER: 401709271
	VISIT DATE: 08/20/2021

NARRATIVE

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Licensee stated there are no guns or ammunition in the home. Smoke and carbon monoxide detectors were tested at 12:10pm and found to be operational. LPA observed the 2 A10 BC fire extinguisher with a service date of 2/17/2021. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee completes and documents emergency drills. The most recent drill was held on 2/16/2021. LPA observed the outdoor activity area which is accessed through the back door of the living room. There is a large tree which provide shade and a variety of toys, climbers with slides and play houses located on artificial grass. The yard is completely fenced.

Licensee and Assistant have current Pediatric CPR and first aid expiring on 10/10/2020. Licensee has met SB 792 immunization requirement. Licensee and Assistant have not completed Mandated Reporter Training per AB 1207. Facility roster and a sample of children's records were reviewed and found complete.

Infant Safe Sleep Regulation section 102425 was discussed. LPA provided PIN 20-24-CCP, Individual Infant Sleep Plan (LIC9227) and a sample Infant Sleep Log for 15 minute checks of all children under the age of two (2) years. LPA provided the “Effects of Lead Exposure” brochure and advised Licensee that the brochure is to distributed to all families at time of enrollment. LPA advised Licensee that Title 22, Division 12 regulations for Family Child Care Homes and California Department of Public Health COVID-19 guidelines for child care programs can be accessed on-line at www.cdss.ca.gov. Licensee stated that she is subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that there are no children enrolled who require medications at this time. 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: www.ada.gov/childqanda.htm

A Type B deficiency was cited today in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee, Natalie Jordan, whose signature on this form confirm receipt of these documents.

LPA provided a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: JORDAN FAMILY CHILD CARE	FACILITY NUMBER: 401709271
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/20/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/03/2021 Section Cited	1 2 3 4 5 6 7	§1596.8662 (b) (1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years... This requirement is no met as evidenced by:
	8 9 10 11 12 13 14	Based on interview, Licensee did not ensure that all adults providing care and supervision to children completed the online Mandater Reporter Training for Child Care providers (AB1207) which poses a potential risk to the health and or safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

LIC809 (FAS) - (06/04)

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