406215976-9-20-2021-17-CC-EBAY-C72PHA-20210920111937

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215976
Report Date: 09/20/2021
Date Signed: 09/20/2021 11:21:04 AM

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: 6	DATE:	09/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Lynsey Delmore		TIME COMPLETED:	11:30 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 9/20/21, at 9:30 AM, Licensing Program Analyst (LPA) Elvin Baddley made an unannounced Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Lynsey Delmore, Licensee of the FCCH and explained the purpose of the inspection. LPA observed six children (one biological) on site during the inspection along with an Assistant (cleared and associated) providing care and supervision. LPA notes the FCCH's living room, two guest bedrooms, bathroom and front yard will be used for child care, while the home's master bedroom, laundry room, kitchen and backyard will be excluded. LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. LPA observed a fireplace (Franklin stove) in the living room which was inaccessible to children and enclosed by a child safety gate. A child safety gate (secured) is observed between the living room and kitchen which is excluded from care. The rear bedroom room is a converted "playroom". Toys in this area are age appropriate and child safety locks are observed on drawers in the area. A crib with tight fitting blanket is observed in a guest room. LPA observed the bathroom used for children care to be clean and free of toxins. Medication in the FCCH 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 a combination carbon monoxide/smoke detector in the home. The detector was tested at 10:00 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 9/20/20. LPA reminded Licensee to purchase or have fire extinguisher serviced annually. LPA was informed a 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 to children in care. Toys and play equipment in the FCCH's interior is age appropriate. The front yard of the home is enclosed by wood fencing. Access/exit gates of the front yard are observed secure. The footing of the front yard consist of grass and a concrete slab. LPA observed no bodies of water (CONT. 809-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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: DELMORE FAMILY CHILD CARE	FACILITY NUMBER: 406215976
	VISIT DATE: 09/20/2021

NARRATIVE

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on site and the front yard is a suitable area to afford child care. Toys and play equipment in the area is age appropriate.

LPA reviewed Licensee's and children's records. The Licensee's records are current with Mandated Reporter training expiring on 11/13/22 and Pediatric CPR/First Aid training expiring on 11/28/22. Children's records are also current as LPA observed emergency contact information as well as immunizations. LPA also review documentation noting children sleep (ages 0-24 months) in 15 minute intervals. A rooster containing children on site was reviewed as was the most recent fire drill which occurred on 4/5/21.

Licensee does not 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 COVID 19 guidance and best practices with the Licensee. Specifically, LPA discussed face covering for children as well as staff members of the FCCH. Licensee was reminded that it is Licensee's responsibility to know the regulations for a FCCH which can be accessed on-line at www.ccld.ca.gov.

In areas evaluated, there were no deficiencies cited at this time.

THE NOTICE OF SITE VISIT WAS POSTED 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: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

LIC809 (FAS) - (06/04)

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