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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215440
Report Date: 07/12/2019
Date Signed: 07/12/2019 02:15:14 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:MERRITT FAMILY CHILD CAREFACILITY NUMBER:
566215440
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
07/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Christine TikotinTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Francisco Pedroza made an unannounced inspection to conduct an Annual/Random inspection. LPA met with licensee Christine Tikotin and advised her the purpose of the visit. LPA and licensee together toured the home inside and out. Licensee has a four bedroom home. There was five children in care at the time of the visit.

The licensee uses the kitchen, family room, one restroom, two bedrooms, and backyard for the day care. Licensee states that there are no fire arms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. LPA observed a fireplace with metal screen in the living room preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The home has functioning smoke and carbon monoxide detectors. Licensee was not able to test the detectors at the time of the visit because the children were sleeping. A 2A10BC fire extinguisher was observed mounted in a closet with a last service date of 08/10/2019. The backyard is fully enclosed with a fence. Licensee has a secured gate leading to where they have a storage unit preventing children from having access. Licensee has age appropriate toys and equipment in the backyard readily accessible for children. Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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: MERRITT FAMILY CHILD CARE
FACILITY NUMBER: 566215440
VISIT DATE: 07/12/2019
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A roster of children in care was observed current and complete. A sampling of children records was reviewed and found current. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Licensee does have liability insurance for their facility. First-Aid and CPR is current until 04/29/2020. Mandated Reporter training is current until 12/10/2019. The Fire/Emergency drill was completed on 04/01/2019. LPA discussed Incidental Medical Services (IMS) with licensee. Licensee currently does not have children in care that require IMS. LPA discussed and provided licensee AB 2370 Lead Exposer guide and Safe Sleep pamphlet.

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

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
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