566210179-6-3-2022-17-CC-MMAW-CF322W-20220603170126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566210179
Report Date: 06/03/2022
Date Signed: 06/03/2022 05:01:36 PM

Document Has Been Signed on 06/03/2022 05:01 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:	BOYER FCC AKA SUBSTITUTE MOM DAY CARE		FACILITY NUMBER:	566210179
ADMINISTRATOR:	JOLYNN BOYER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 520-8023
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	14	CENSUS: 3	DATE:	06/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Jolynn Boyer		TIME COMPLETED:	05:15 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 6/3/22 at 2:15 pm Licensing Program analyst (LPA) Michael Mathew conducted an unannounced annual visit LPA met with Licensee Jolynn Boyer and discussed the purpose of the Visit. Prior to entering the home LPA conducted Covid-19 screening questions. Licensee and LPA toured inside and out of the home. At the time of the visit there were 3 children and 2 adults. There are age appropriate toys and equipment for children in care. Licensee uses the living room, play room, hallway bathroom, and backyard for the day-care. LA observed a gate for upstairs which is off limits to children in care. Licensee stated that there are guns and ammunition in the home LPA observed the guns are kept in a safe in the garage both the guns and ammunition are kept separated inside the safe and is off limit to children in care. LPA observed the knifes were were kept in a box on top of a cabinet in the kitchen inaccessible to children. LPA observed chemicals and toxins are kept in the laundry room and under the sink which is locked and is inaccessible to children in care. Backyard is fully fenced in and have ample amount of toys and equipment for children in care. LPA observed no bodies of water during inspection. Licensee stated that they will be remodeling the backyard with the grant that was approved. LPA mention to licensee to provide a plan insuring, children will be safe and also an updated facility sketch once completed. LPA observed a 2A10BC fire extinguisher present licensee did not have current receipt of for fire extinguisher. Fire alarm and carbon monoxide detector are good and in working condition.Licensee did not test fire alarm or carbon monoxide detector due to children sleeping. Licensees and assistant CPR/first aid is current and is valid until 12/6/23. Licensee present have current mandated reporter training valid until 8/17/2023. Assistant present did not have a current mandated reporter training, Fire drill was conducted on 5/5/22. Cont-D

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

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: BOYER FCC AKA SUBSTITUTE MOM DAY CARE	FACILITY NUMBER: 566210179
	VISIT DATE: 06/03/2022

NARRATIVE

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The facility is currently not providing 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

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/inspection-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.

A notice of site visit was given and must remain posted for 30 days

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee.

2 type B deficiencies was cited in today’s visit.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/03/2022 05:01 PM - It Cannot Be Edited

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: BOYER FCC AKA SUBSTITUTE MOM DAY CARE	FACILITY NUMBER: 566210179
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which pose a potential health, safety or personal rights risk to persons in care. Child was constantly taking receipt out, Licensee gave receipt to Accountant.
	POC Due Date: 06/07/2022
	Plan of Correction
1 2 3 4	Licensee agreed to send copy of fire extinguisher receipt to LPA via text by end of day Tuesday 6/7/2022

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee assistant was not able to retrieve certificate via email that was used for mandate reporter training
	POC Due Date: 06/07/2022
	Plan of Correction
1 2 3 4	licensee agreed to send copy of assistant mandated training certificate to LPA via text by end of day Tuesday 6/7/2022

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael Mathew	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

LIC809 (FAS) - (06/04)

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