406215976-11-25-2020-17-CC-EBAY-BVPSM5-20201125125923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215976
Report Date: 11/25/2020
Date Signed: 11/25/2020 12:59:47 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:	DELMORE FAMILY CHILD CARE		FACILITY NUMBER:	406215976
ADMINISTRATOR:	LYNSEY DELMORE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 503-9433
CITY:	ARROYO GRANDE	STATE: CA	ZIP CODE:	93420
CAPACITY:	14	CENSUS: 1	DATE:	11/25/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lynsey Delmore		TIME COMPLETED:	10:30 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	On 11/25/20, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley made an announced Prelicensing Inspection of the abovementioned home. LPA met with Lynsey Delmore, Applicant of the home and explained the purpose/nature of the inspection. The Applicant's biological child was on site at the time of the inspection. Applicant informed LPA of intention to operate as a Family Child Care Home (FCCH) from 7:30 AM to 5:30 PM, Monday to Friday. Due to COVID 19 and the California Department of Public Health's guidelines for social distancing, this inspection was conducted virtually, via the Face Time application. LPA asked Pre screening Tele-Inspection questions prior to the inspection. All responses received by the Applicant are indicative of non COVID exposure on site. LPA toured the interior and exterior of the home in its entirety. The home is a three bedroom, one bathroom single story dwelling. Applicant informed LPA the home’s living room, two guest bedrooms, bathroom and front yard will be used for child care. Conversely, the home's master bedroom, laundry room, kitchen and backyard will be excluded from child care. LPA observed a fireplace (Franklin stove) in dining room which was inaccessible to children and enclosed by a child safety gate. The bathroom to be used for children care has two sinks and a single toilet. LPA observed the bathroom to be clean and free of toxins. Medication in the home is stored on an elevated shelf in a cabinet bathroom. Additionally, cleaning compounds in the home are stored under sink cabinets in both the bathroom and kitchen. Each cabinet is secured by a child safety lock making medication and cleaning compounds inaccessible to children. LPA observed carbon monoxide and smoke detectors in the home. Each detector was tested at 9:40 am and found to be operable. The home has appropriate ventilation to account for child care. LPA observed a regulation fire extinguisher on site which was purchased on 2/11/20. LPA reminded Applicant to purchase or have fire extinguisher serviced annually. Applicant informed LPA firearm and ammunition is on site. LPA observed the location of firearm and ammunition and notes each is stored separately and in an exclude area of the home, which is inaccessible (CONT. 802-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020

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: DELMORE FAMILY CHILD CARE	FACILITY NUMBER: 406215976
	VISIT DATE: 11/25/2020

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

to children.

The front yard of the home is enclosed by wood fencing. Access/exit gates of the front yard are capable of being secured by lock. The footing of the front yard consist of grass and a concrete slab. LPA observed no bodies of water on site and the front yard is a suitable area to afford child care.

LPA's record review revealed Applicant completed Preventative Health training on 11/7/20 and Mandated Reporter training on 11/13/20. The Applicant is scheduled to take Pediatric CPR/First Aid training on 11/28/20. LPA reminded Applicant the aforementioned must be completed prior to the issuance of a regular FCCH license. LPA also verified documentation of experience. LPA reviewed Applicant's control of property document in the form of a lease agreement. Applicant does not have liability insurance at this time. LPA informed Applicant to ensure parents sign a waiver for the liability insurance (Applicant was provided LIC 282 form). LPA notes a Fire Clearance was granted for the home by Cal Fire following an inspection conducted on 11/10/20.

Applicant has expressed a desire to provide Incidental Medical Services (IMS). IMS policies were discussed. 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 FCCH and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed AB 633 and provided Prelicensing packet to Applicant. LPA reviewed and issued the Applicant updated samples of state required forms to be kept in the children's records. LPA also discussed and provide the Applicant guidelines to Safe Sleep, Effects of Lead Exposure leaflets as well as literature related to COVID 19 safeguards and best practices (RAST TA visit completed). Applicant was informed baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. Applicant was made aware it is Applicant's responsibility to know the regulations for FCCH which can be accessed online at www.ccld.ca.gov.

The home meets the requirement for a Large FCCH. Applicant will be afforded a Provisional FCCH license, effective 11/25/20, for a period of 90 days. Regular licensure will be granted after the Applicant present certification of the completion of Pediatric CPR and First Aid training to CCLD. The Notice of Site Visit was provided as required by H&S CODE SEC. 1596.817. The Notice of Site Visit must remain posted for 30 days or a Civil Penalty of $100.00 will apply.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2