406213123-7-6-2023-17-CC-DMWT-CTGV8P-20230706161303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406213123
Report Date: 07/06/2023
Date Signed: 07/06/2023 04:13:16 PM

Document Has Been Signed on 07/06/2023 04:13 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	MCKENZIE FAMILY CHILD CARE		FACILITY NUMBER:	406213123
ADMINISTRATOR:	JAMIE MCKENZIE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 423-3188
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	14	CENSUS: 7	DATE:	07/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Jamie Mckenzie		TIME COMPLETED:	04:30 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 07/06/23, at 2:20 PM, Licensing Program Analyst (LPA) Dixie Wright conducted an unannounced Required Annual inspection of this Family Child Care Home (FCCH). LPA met with Jamie McKenzie, Licensee, and toured the interior and exterior of the FCCH. The living room, dining room, hallway bathroom, kitchen, back room to the right in the hallway and part of the backyard are used for child care, while the remainder of the home is excluded. LPA observed seven children on site, (two are infants) along with one assistant, (cleared and associated). LPA observed required licensing forms and documents posted on the wall in the entryway. LPA observed a smoke detector in the living room, tested at 2:47 and functioning. A carbon monoxide detector was in entryway, tested at 2:48 and functioning. The FCCH has a regulation fire extinguisher, serviced on 11/09/2023. Licensee is aware to either service or purchase a regulation fire extinguisher annually. Last fire drill was done 02/10/2023. LPA observed age appropriate toys, furniture and equipment in the FCCH's interior. LPA observed the restroom used by children to be clean and free of toxins. Medications/vitamins are stored in an elevated cabinet in the kitchen, inaccessible to children. LPA observed cleaning compounds in an elevated cabinet in the kitchen. Sharps are stored in an elevated cabinet in the kitchen inaccessible to children. The backyard is enclosed by wooden fencing and the footing in the area is cement, grass, and wood chips, with a sandbox area. Toys and play equipment observed on site are age appropriate. The fence’s entry/exit gate is secure. Facility has an above ground swimming pool, fully secured with a five foot gate and inaccessible to children. Children's records were reviewed. The records are current, complete and possessed emergency contact information as well as immunization records. LPA could not review documentation noting... (CONT. LIC 809-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MCKENZIE FAMILY CHILD CARE	FACILITY NUMBER: 406213123
	VISIT DATE: 07/06/2023

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
26
27
28
29
30
31
32

the infant's sleep checks have been conducted in 15 minute intervals for infants in care. Facility roster for children in care is current. The Licensee's records were also reviewed. Pediatric CPR and First Aid had expired 10/10/2021. Licensee and assistant did not have current Mandated Reporter training. Licensee stated no firearms or ammunition is stored on site.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
CONT on 809-C....

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MCKENZIE FAMILY CHILD CARE	FACILITY NUMBER: 406213123
	VISIT DATE: 07/06/2023

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
26
27
28
29
30
31
32

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Jamie McKenzie confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee Licensee Jamie McKenzie.

Deficiencies cited on attached 809-D's.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 07/06/2023 04:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MCKENZIE FAMILY CHILD CARE	FACILITY NUMBER: 406213123
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(C)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Infants up to 12 month of age who are sleeping in a position other than on their back. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two out of two infants which poses a potential safety risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	Per Licensee, she does 15 minute checks, but has not been documenting them. LPA provided Licensee with a sample 15 minute check template. Licensee stated she will document the 15 minute checks from now on. Proof of correction will be sent to CCLD by 07/14/23.

Section Cited

Infant Safe Sleep


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 07/06/2023 04:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MCKENZIE FAMILY CHILD CARE	FACILITY NUMBER: 406213123
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

On or before March 30th, 2018, a person who is a licensed child care provider, adminstrator or employee of a licensed child day care facility shall complete the mandated reporter training....and shall complete the renewal every two years. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two out of two staff which poses a potential safety risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	Licensee will take the Mandated Reporter training and send proof to LPA by 07/14/2023.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements- The Licensee and other personnel as specified shall complete training on preventative health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuan to Healht and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of two staff, which poses a potential safety risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	Licensee will take the First Aid/CPR class and send proof to LPA by 07/14/2023.

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: Dixie Marie Wright	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5