406215697-1-24-2023-17-CC-GRES-CNDRWH-20230124122311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215697
Report Date: 01/24/2023
Date Signed: 01/24/2023 12:23:20 PM

Document Has Been Signed on 01/24/2023 12:23 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:	COURTNEY FCC AKA EARTH BABY INFANT & TODDLER CARE		FACILITY NUMBER:	406215697
ADMINISTRATOR:	TAMARA L. COURTNEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 503-8121
CITY:	NIPOMO	STATE: CA	ZIP CODE:	93444
CAPACITY:	14	CENSUS: 6	DATE:	01/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Tamara Courtney		TIME COMPLETED:	12:30 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 January 24, 2023 at 10:30 AM, , Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced One (1) Year Required inspection. LPA asked pre- screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID 19 exposures on site. LPA met with licensee, Tamara Courtney and discussed the purpose of the inspection. There were 6 children present during the inspection, 3 of whom are infants. LPA in the company of Licensee toured the interior and exterior of the day care. Family Child Care Home (FCCH) has a dedicated day care room and nap room. Day care area has a separate entrance from the main house. Children are dropped off and picked up using the side gate at the right side of the home. LPA observed required licensing forms are posted in the wall. LPA observed smoke and carbon monoxide detectors in the FCCH. The fire extinguisher was serviced on 12/21/2021. Licensee was reminded that fire extinguisher should be serviced every year or to purchase a new one. Home conducts and documents fire and disaster drill every 6 months last drill was conducted on 1/6/2023. Bathroom was observed to be free of toxins. Hazardous items and cleaning materials are kept inaccessible to day care children. The backyard is enclosed with appropriate fence. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home. LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 4/24/2023. Licensee is scheduled to renew the CPR Training on 2/8/2023. Licensee took Mandated Reported Training certificate which will expire on 3/11/2024. FCCH has current roster of children in care. A sampling of children records were reviewed and found to be current. Infants in care have Individual Safe Plan on file, Licensee also checks and documents napping infants every 15 minutes. Continued on LIC 809C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023

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: COURTNEY FCC AKA EARTH BABY INFANT & TODDLER CARE	FACILITY NUMBER: 406215697
	VISIT DATE: 01/24/2023

NARRATIVE

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Licensee does not provide Incidental Medical Services (IMS). 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.

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 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
Licensee was reminded that all adults 18 year old 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.

During today's inspection, deficiency was cited under Title 22 Division 12. TAppeal Rights were given and discussed.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Tamara Courtney

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/24/2023 12:23 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: COURTNEY FCC AKA EARTH BABY INFANT & TODDLER CARE	FACILITY NUMBER: 406215697
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above in fire extinguisher was serviced on 12/21/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/03/2023
	Plan of Correction
1 2 3 4	LIcensee agreed to purchase a new fire extinguisher or service the existing one, and submit the plan of correction to Community Care Licensing no later thatn 2/3/2/2023.

Section Cited


	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: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023

LIC809 (FAS) - (06/04)

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