401709271-8-19-2022-17-CC-FPEA-CHFTQB-20220819145540

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401709271
Report Date: 08/19/2022
Date Signed: 08/19/2022 02:55:44 PM

Document Has Been Signed on 08/19/2022 02:55 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, 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: 5	DATE:	08/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:07 PM
MET WITH:	Natalie Jordan		TIME COMPLETED:	03:10 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 August 19, 2022 at 1:13 PM, Licensing Program Analyst (LPA) Frank Pedroza conducted an unannounced Annual/Random inspection. LPA met with Licensee Natalie Jordan and advised her the purpose of the inspection. Licensee provided LPA a tour of the facility inside and out. There were five (5) children in care and two (2) assistants providing supervision at the time of the inspection. Licensee has a single story home. Children have access to the living room, kitchen, one (1) restroom, back room (classroom), and front yard. The bedrooms and back yard are off limits to children in care. LPA did not observe any hazards/toxins accessible to children in care. Licensee stores their medications, knives, and cleaners/disinfectants in the top cabinets of the kitchen. Licensee advised that she generally provides the snack and food for children while care. LPA observed a 2A10BC fire extinguisher mounted on the wall with a service date of 3/11/22. Licensee is reminded to service or purchase a new fire extinguisher annually. LPA observed the smoke and carbon monoxide detectors in the home. They were not tested during the inspection because the children were sleeping at the time. In the classroom LPA observed licensee had age appropriate books, activities, toys, games and furniture readily accessible for the children. In the front yard the licensee has a section fenced off for the children to play. LPA observed age appropriate toys and structures readily accessible for the children. There is a large tree in the center of the front yard providing a large amount of shade for the children. The backyard is enclosed with a fence that is secured. LPA observed the licensee has a trampoline in the backyard. Licensee advised that the backyard is off-limits to day care children. Licensee advised LPA there are no firearms or live ammunition in the home. LPA reviewed the facility child roster and found it to be complete. LPA reviewed a sampling of children and staff records. Children records were found to be current and complete. The staff records were found to be current and complete. All staff had current Mandated Reporter and Pediatric CPR/First-aid certificates. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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: 08/19/2022

NARRATIVE

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The last fire drill was conducted on 7/7/22. Licensee is following current Covid-19 requirements.

No deficiencies were cited during today's inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

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/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 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC809 (FAS) - (06/04)

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