426216010-10-27-2020-17-CC-FPEA-BUSSV6-20201027141212

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216010
Report Date: 10/27/2020
Date Signed: 10/27/2020 02:12:26 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:	CHAPMAN FCC AKA POSY		FACILITY NUMBER:	426216010
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/27/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Alexis Chapman		TIME COMPLETED:	02:10 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 10/27/2020 at 1:02 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted PRE-LICENSING inspection. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPA met with Applicant Alexis Chapman. The tele-inspection was conducted via Facetime. During this tele-inspection the applicant provided the LPA a tour of the home inside and out. Applicant has a three bedroom and two bath home. She will be using one bedroom, one bathroom, living room, dining room, and back yard for care. LPA observed the rest of the home and kitchen have secured gates to prevent children from accessing them. LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher was purchased on 8/17/2020 was observed in the closet. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA observed the home has functioning smoke and carbon monoxide detectors. There are age appropriate toys and day-care equipment in the home. The back yard has age appropriate toys and day-care equipment. LPA observed sufficient shade for children to have access to. LPA advised applicant must provide visual supervision while the children are playing outside in the backyard. Preventative Health & Safety and Nutrition Training completed on 7/20/2020. Applicant First Aid/CPR certificates is valid until 06/16/2022. Applicant AB 1207 Mandated Reporter Training Certificate expires 10/07/2022. Applicant advised they do have a firearm and ammunition in the home located in her room. LPA observed both are stored and secured separated from one another. LPA advised licensee to ensure they are secured at all time and out of reach of children. Currently the applicant does not have liability insurance. LPA informed applicant that she will need parents to sign a waiver for the liability insurance for each child enrolled. Applicant provided lease agreement to verify control of property. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

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: CHAPMAN FCC AKA POSY	FACILITY NUMBER: 426216010
	VISIT DATE: 10/27/2020

NARRATIVE

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LPA discussed and verify SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). Applicant was informed walkers, bouncers and any similar object that restricts children's movement is prohibited from licensed facilities.

LPA reviewed, discussed and gave applicant updated samples of state required forms to be kept in the children's file, required forms to be posted and forms that needs to be maintained at the Family Child Care Home (FCCH). LPA discussed information about Sudden Infant Death Syndrome, Never Shake a Baby, and Capacity requirements. A guide to Effects of lead poisoning and Safe Sleep pamphlet was provided to applicant. Applicant was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov.

No deficiencies cited during this visit. License to operate a Family Child Care facility is effective today 10/27/2020.

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: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020

LIC809 (FAS) - (06/04)

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