566206478-6-9-2022-17-CC-DTHN-CF8TSC-20220609145855

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566206478
Report Date: 06/09/2022
Date Signed: 06/09/2022 02:58:59 PM

Document Has Been Signed on 06/09/2022 02:58 PM - It Cannot Be Edited

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:	KISSICK FCC AKA CAMP KISSICK		FACILITY NUMBER:	566206478
ADMINISTRATOR:	BRENDA I. KISSICK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 373-1486
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	14	CENSUS: 8	DATE:	06/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Brenda Kissick		TIME COMPLETED:	03:15 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 June 9, 2022 at 1:00 PM, Licensing Program Analyst Dean Thompson and Susana Martinez conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with licensee Brenda Kissick and advised the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There were eight children in care at the time of the inspection. LPA observed required licensing documents mounted on the wall inside the day-care room. Fire and earthquake drills are being documented every six months. Last drill was conducted on 4/12/2022. Fire extinguisher 2A10BC mounted on the wall inside the day-care room has a purchase date of 12/29/2021. Fire and carbon monoxide detectors were observed.. Children in care have access to the living room, day-care room, master bedroom, laundry room, and back yard. Fire place inside the living room is screened to prevent access by children. Children have access to toys that are age-appropriate inside and outside of the home. Back yard play area is enclosed and has plenty of play structures. Licensee has a dog and six tortoises located in the back yard separate from the childrens play area. Licensee stated there are no guns or ammunition inside the home. There are no bodies of water present at the time of inspection. During the tour, LPA did not observe any hazards/toxins items accessible to children in care. LPA reviewed a sampling children files. All children files were current and safe sleep logs were reviewed. Licensee CPR/first aid is valid through 5/18/2023. Licensee mandated reporter certification is current until 7/14/2022. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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: KISSICK FCC AKA CAMP KISSICK	FACILITY NUMBER: 566206478
	VISIT DATE: 06/09/2022

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA observed a safe sleep log being documented for infants in care every 15 minutes.

Licensee advised there were no children in care that required Incidental Medical Services. 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

There were no deficiencies cited during todays inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee Brenda Kissick

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC809 (FAS) - (06/04)

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