566211292-4-7-2022-17-CC-DTHN-CD9QFJ-20220407120800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566211292
Report Date: 04/07/2022
Date Signed: 04/07/2022 12:08:15 PM

Document Has Been Signed on 04/07/2022 12:08 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:	FERENCE FAMILY CHILD CARE AKA CREATIVE LITTLE MIND		FACILITY NUMBER:	566211292
ADMINISTRATOR:	TINA TERRIO FERENCE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 341-8468
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	14	CENSUS: 7	DATE:	04/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Tina Ference		TIME COMPLETED:	12:30 PM

NARRATIVE

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On April 7, 2022 at 9:10 AM, Licensing Program Analysts (LPA) Dean Thompson and Rona Chavez conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with licensee Tina Ference and advised the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There were seven children in care at the time of the inspection along with licensee and one staff (S1).

When entering the home at 9:10 AM LPA asked staff (S1) to provide her name. LPA reviewed records and was determined staff (S1) was not associated to the facility or been fingerprint cleared. Staff (S1) and licensee stated she has been working at the facility for three months and was hired in January 2022.

During the Inspection LPA noticed facility license, PUB 394 Notification of Parents Rights, and emergency disaster plan were posted at entrance. Last fire drill conducted on 4/4/2022. Fire extinguisher 2A10BC has a purchase date of 7/24/2021. Licensee stated there are no firearms or ammunition on the property.

When Children are in care, children have access to the back home, one bathroom, and back yard. During the tour, LPA did not observe any hazards/toxins items accessible to children. Licensee's back yard has different sorts of animals in cages, inaccessible to children, but children can watch them through the chain link fence, while they play on different play structures placed on the grass area during outdoor activities. A pool is located on the property which is enclosed by a six foot fence making it inaccessible to children.

****Continued on LIC 809-C****

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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: FERENCE FAMILY CHILD CARE AKA CREATIVE LITTLE MIND	FACILITY NUMBER: 566211292
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above. When entering the home at 9:10 AM LPA asked assistant to provide her name. LPA reviewed records and it was determined the assistant was not associated to the facility or been fingerprint cleared. Assistant and licensee stated she has been working at the facility for three months which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/07/2022
	Plan of Correction
1 2 3 4	LPA observed S1 leave the facility during the visit. Licensee agreed to have S1 submit fingerprints before being able to assist in the day care.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/07/2022 12:08 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: FERENCE FAMILY CHILD CARE AKA CREATIVE LITTLE MIND	FACILITY NUMBER: 566211292
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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, interview, and record review, the licensee did not comply with the section cited above. Licensee was reminded in 2018 at last annual visit to complete the mandated reporter training. Licensee did not comply and was unable to provide proof of the mandated reporter certification which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/21/2022
	Plan of Correction
1 2 3 4	Licensee agreed to complete Mandated Reporter Training AB1207 by Plan of Correction due date. Licensee was given the website information to complete the training by LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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: FERENCE FAMILY CHILD CARE AKA CREATIVE LITTLE MIND	FACILITY NUMBER: 566211292
	VISIT DATE: 04/07/2022

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LPA reviewed licensee and children files. All children files were current. Licensee advised there were no children in care that required Incidental Medical Services. Licensee was unable to provide proof of her Mandated Reporter Certification. Licensee was reminded to complete the training during her last annual inspection on 8/6/2018. Licensee CPR is current and expires 7/2023

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.

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

LPA Thompson informed licensee Tina Ference that this report dated 4/7/2022 document(s) One Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Thompson informed the licensee Tina Ference to provide a copy of this licensing report dated 4/7/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Two deficiencies were cited during today's inspection. One Type A and one Type B.

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, Tina Ference.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC809 (FAS) - (06/04)

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