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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216010
Report Date: 09/17/2021
Date Signed: 09/17/2021 02:32:24 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 POSYFACILITY NUMBER:
426216010
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Alexis ChapmanTIME COMPLETED:
02:35 PM
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On 09/17/21 at 1:40pm, Licensing Program Analyst (LPA) Christian Patterson made an unannounced inspection to the home for the purpose of conducting a REQUIRED 1-YEAR inspection. LPA met with Licensee Alexis Chapman and explained the purpose of the inspection. There were 5 children present. A tour of the home was made both inside and outside. Licensee utilizes the living room, dining area, library, bathroom, and backyard for care. The backyard is fully secured with a fence. The off-limits areas are two bedrooms, one bathroom, and kitchen which are secured with gates to ensure children do not have access. The regulation fire extinguisher was last serviced on 11/2020. Licensee is reminded to either service or purchase a regulation fire extinguisher every year. The smoke and carbon monoxide detector were observed to be functional. LPA observed that there are age appropriate toys and equipment both inside and outside. LPA did not observe any bodies of water. 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 reviewed a sampling of children's records. Immunization records were complete for all adults in the facility. Licensee's First Aid/CPR certificates are valid until 06/16/2022. Licensee has completed AB1207 Mandated Reporter Training which is valid until 10/2022. A fire/disaster drill was completed on 09/17/21.


Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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: CHAPMAN FCC AKA POSY
FACILITY NUMBER: 426216010
VISIT DATE: 09/17/2021
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Licensee is reminded that they are responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov. LPA reviewed the handouts Safe Sleep- Frequently Asked Questions, and the Effects of Lead Exposure.

There were no deficiencies cited today. The LIC 9213 (Notice of Site Visit) was posted in LPA's presence.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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