566211269-1-15-2020-17-CC-JMHL-BKUSYD-20200115131723

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566211269
Report Date: 01/15/2020
Date Signed: 01/15/2020 01:17:30 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:	RUSSELL FAMILY CHILD CARE		FACILITY NUMBER:	566211269
ADMINISTRATOR:	JODI RUSSELL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 797-4421
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	14	CENSUS: 11	DATE:	01/15/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Jodi Russell		TIME COMPLETED:	01:30 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 01/15/2020, at 12 p.m. Licensing Program Analyst, (LPA) Jill Laxo conducted an unannounced annual inspection and met with licensee Jodi Russell and assistant Karlee Kennedy. The purpose of the inspection was discussed with the Licensee and together we toured the home inside and out. During today's visit the Licensee had 11 children in care. The facility is a two story home, the day care is primarily conducted on the first floor and backyard. Detergents, cleaning products, medication and other items which could pose a danger are stored and inaccessible to children. There is a covered and locked hot tub located in the backyard on the property. Licensee states there are no firearms in the home. Fire extinguisher is a 2A10BC was last serviced July 2019. The home has working smoke and carbon monoxide detectors. Licensee has all required forms posted for parents to view. Safe toys and play equipment are provided and the children have comfortable accommodations. The last emergency drill was conducted on 12/15/2019. Licensee has current roster of children. Children's file have required forms. Licensee has current Pediatric CPR/First Aid which expires on 03/2020. Assistant has completed AB1207 Mandated Reporter Training which expires on 03/08/2018. Continued on 809 C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020

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: RUSSELL FAMILY CHILD CARE	FACILITY NUMBER: 566211269
	VISIT DATE: 01/15/2020

NARRATIVE

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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

A Guide to Safe Sleep and Effects of Lead Exposure brochures were provided.

No deficiencies were cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020

LIC809 (FAS) - (06/04)

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