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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401710383
Report Date: 09/07/2021
Date Signed: 09/07/2021 04:05:05 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:ANDERSON FAMILY CHILD CAREFACILITY NUMBER:
401710383
ADMINISTRATOR:ANDERSON, JANETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 466-0907
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 10DATE:
09/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:09 PM
MET WITH:Janet AndersonTIME COMPLETED:
04:10 PM
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On 9/7/2021 at 3:09pm, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 with Licensee, Janet Anderson. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee and both adult assistants wore face coverings. LPA observed the required documents posted inside of the home on the wall adjacent to the front door. There were 10 children (4 of which were infants) eating snack in the kitchen. Child care services are provided in the the front room, living room, and dining room. LPA observed age appropriate toys, books, portable cribs and high chairs. There is fireplace in the living room which is barricaded with a safety gate. There are three (3) bedrooms which are inaccessible to children and kept locked. One bedroom is used for napping infants; Licensee indicated that she understands the door must remain open while infants are napping. The bathroom used by children was observed to be clean and free of toxins.

Licensee stated there are no guns or ammunition in the home. Detergents, cleaning compounds, medications and other items such as kitchen knives which could pose a danger to children are stored inaccessible to children. Smoke and Carbon monoxide detectors were tested at 3:15pm and found to be operational. LPA observed the 2 A10 BC fire extinguisher with a service date of 3/1/2021. Licensee completes and documents monthly emergency drills. The most recent drill was held on 9/1/21.

LPA observed the outdoor activity areas located in the fenced driveway at the front of the home and in the backyard. Both areas contain a variety of toys. The backyard has climbers with cushioning to absorb a fall. There is a spa located on the far side of the back yard which has a cover and an additional weighted tarp making it inaccessible to children. There is also a fenced garden beyond the outdoor activity area which is off limits to children.

Licensee and Assistants have met SB 792 immunization requirement, have current Pediatric CPR and first aid expiring on 3/5/2022 and completed Mandated Reporter Training per AB 1207 in 2021. Cont. on 809-C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ANDERSON FAMILY CHILD CARE
FACILITY NUMBER: 401710383
VISIT DATE: 09/07/2021
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 LPA reminded Licensee that the training must be renewed every two (2) years. 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. Licensee reported that the “Effects of Lead Exposure” brochure is 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. COVID19 Information for San Luis Obispo County can be found at https://www.emergencyslo.org/en/covid19.aspx. 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

In the areas evaluated today, no deficiencies were cited.

A copy of this report and appeal rights were discussed and left with Licensee, Janet Anderson, 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 MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
LIC809 (FAS) - (06/04)
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