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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215588
Report Date: 06/11/2021
Date Signed: 06/11/2021 11:12:55 AM

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:KISSICK FAMILY CHILD CARE AKA LUV BUGS DAYCAREFACILITY NUMBER:
566215588
ADMINISTRATOR:AUBRYE KISSICKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 906-0322
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:14CENSUS: 10DATE:
06/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Aubrye KissickTIME COMPLETED:
11:20 AM
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On June 11, 2021 at 10:01 am, Licensing Program Analysts (LPAs) Francisco Pedroza and Austin Rios conducted an unannounced annual inspection. LPAs met with Licensee Aubrye Kissick and advised her the purpose of the inspection. Licensee provided LPAs a tour of the facility inside and out. There were 10 children in care at the time of the inspection.

The licensee uses the kitchen, family room, one restroom, two bedrooms, and the back yard 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. LPAs observed stored medications. LPAs observed age appropriate toys and furniture readily accessible to children. The home has working smoke and carbon monoxide detectors. A 2A10BC fire extinguisher was observed mounted in a closet with a purchase date of 7/1/2020. The backyard is fully enclosed with wood fence. There is an outdoor building secured to the garage. LPAs observed an outdoor spa with the top properly secured preventing children from having access. LPAs observed age appropriate toys and play structures in the backyard readily accessible to 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: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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: KISSICK FAMILY CHILD CARE AKA LUV BUGS DAYCARE
FACILITY NUMBER: 566215588
VISIT DATE: 06/11/2021
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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. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Pediatric First-Aid and CPR is current until 1/10/2023. Mandated Reporter training is current until 5/28/2023. The Fire/Emergency drill was completed on 6/9/2021. LPA discussed Incidental Medical Services (IMS) with licensee. Licensee currently does have children in care that require IMS. LPA discussed current Safe Sleep requirements and guidelines with licensee.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
LIC809 (FAS) - (06/04)
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