406215947-4-5-2020-17-CC-GRES-BNE67X-20200405203418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215947
Report Date: 04/02/2020
Date Signed: 04/05/2020 08:35:23 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:	HURSELL FAMILY CHILD CARE		FACILITY NUMBER:	406215947
ADMINISTRATOR:	KAILA N. HURSELL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 674-4631
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	14	CENSUS: 0	DATE:	04/02/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Kaila Hursell		TIME COMPLETED:	09:20 AM

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	This is a change of location, prior license no. 406215018. On 4/2/2020, Licensing Program Analyst (LPA) Gigi Reyes conducted pre licensing tele-inspection and had a video conference with the Licensee/Applicant, Kaila Hursell. LPA conducted a virtual tour of the home. This is a two story home composed of three bedrooms and 3 baths. Living room is the designated day care are. Kitchen, 2 bedrooms are accessible to day care children. The 2nd floor is barricaded with a baby gate. Garage is not accessible to day care children. Licensee stated fire arms and ammunition are stored separately in two different vaults There are no bodies of water in the home. During the virtual tour, LPA observed licensing forms are posted, Fire extinguisher meets the State Fire Marshall standards which was purchased on 3/13/2020. Carbon monoxide and smoke detector were tested and found functional. All hazardous items such as cleaning products are stored in a locked cabinet, toxins, laundry detergent are stored in the garage which is inaccessible to day care children. LPA observed safe and age appropriate toys. The backyard is appropriately fenced, clean and in order. Licensee/Applicant stated there are no bodies of water. Licensee/Applicant submitted the following documents prior to tele inspection, records immunization, MMR, TDAP and flu shots. Adult and Infant CPR and First Aid expires 4/5/2021. AB 1207 Mandated Reporter Training was taken on 12/17/2019. Fire drill is performed every 6 months and properly documented. The control of property was verified. LPA discussed the Safe sleep Best Practices and Effects of Lead Exposure, fliers will be provided to parents of day care children. Licensee/Applicant was advised to visit ccld.ca.gov for quarterly updates and Provider's Information Notices.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2020

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: HURSELL FAMILY CHILD CARE	FACILITY NUMBER: 406215947
	VISIT DATE: 04/02/2020

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Licensee/Applicant is not providing Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes 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

A 90 day Provisional License is approved for a Small Family Child Care effective today, 4/2/2020. License will be converted to a Large Family Child Care Home once Fire Safety Inspection Clearance is granted.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2020

LIC809 (FAS) - (06/04)

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