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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215440
Report Date: 07/13/2022
Date Signed: 07/13/2022 01:52:42 PM


Document Has Been Signed on 07/13/2022 01:52 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:MERRITT FAMILY CHILD CAREFACILITY NUMBER:
566215440
ADMINISTRATOR:CHRISTINE MARIE TIKOTINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 432-2843
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:14CENSUS: 6DATE:
07/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:CHRISTINE MARIE TIKOTINTIME COMPLETED:
02:07 PM
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On 7/13/2022 at 12:00 PM Licensing Program analyst (LPA) Michael Mathew Conducted an unannounced annual visit LPA met with Licensee Christiine Tickotin 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 6 children and 2 adults. There are age appropriate toys and equipment for children in care.

Licensee uses the living room, play room, hallway bathroom, 2 bedrooms and backyard for the day-care. Licensee stated that there are no guns/weapons or ammunition in the home. LPA observed the knifes were were kept in the cabinet inaccessible to children. Licensee stated that chemicals and toxins are kept in the garage with is off limits to children in care. LPA observed fire place which is covered with a metal gate making it 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. LPA observed a 2A10BC fire extinguisher present and serviced on 9/13/21. Fire alarm and carbon monoxide detector are good and in working condition. Licensees CPR/first aid is current and is valid until 3/4/24. Licensee and one assistant present have current mandated reporter training valid until 11/29/23 and 5/10/23. Fire drill was conducted on 4/4/2022.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

cont 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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: MERRITT FAMILY CHILD CARE
FACILITY NUMBER: 566215440
VISIT DATE: 07/13/2022
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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/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.

"No deficiency was cited in today’s visit"

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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