566211269-8-17-2022-17-CC-RCHZ-CHDVNJ-20220817163512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566211269
Report Date: 08/17/2022
Date Signed: 08/17/2022 04:35:20 PM

Document Has Been Signed on 08/17/2022 04:35 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:	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: 14	DATE:	08/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Jodi Russell		TIME COMPLETED:	04:48 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 August 17, 2022 at 2:35 PM, Licensing Program Analyst (LPA) Rona Chavez conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with licensee Jodi Russell and advised the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There were 14 children in care and one assistant at the time of the inspection. The licensee uses the play room, kitchen, dining room, living room, family room, one restroom, and backyard for the day-care. LPA observed age appropriate toys and furniture readily available for the children in care. LPA observed a fireplace with a screen in front preventing children from having access. Licensee states that there are no firearms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. The backyard is fully enclosed with a brick wall. Licensee has age appropriate toys and play structures in the backyard in good condition and free of hazards. LPA observed a covered and locked hot tub in the back yard that is currently empty. The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the hallway with a service date of 3/15/2022 A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete. Licensee does not currently provide Incidental Medical Services. Continued on LIC809-C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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: RUSSELL FAMILY CHILD CARE	FACILITY NUMBER: 566211269
	VISIT DATE: 08/17/2022

NARRATIVE

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Licensee has AB 1207 Mandated Reporter Training Certificate on file with an expiration date of 6/7/2023. CPR/First Aid is current with a expiration date of 3/2024. The last fire drill was conducted on 8/01/2022.

Licensing is following all Infant Safe Sleep Regulations. LPA observed play yards for each infant and licensee is documenting 15 minute checks.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

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.

Incidental Medical Services (IMS) 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 IMA 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 Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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: 08/17/2022

NARRATIVE

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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.

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

Exit interview conducted and report was reviewed with the licensee Jodi Russell.

Copy of report and appeal rights were provided.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC809 (FAS) - (06/04)

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