566215923-5-14-2020-17-CC-FPEA-BPLUYT-20200514160027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215923
Report Date: 05/14/2020
Date Signed: 05/14/2020 04:01:47 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:	CRAVITZ FAMILY CHILD CARE		FACILITY NUMBER:	566215923
ADMINISTRATOR:	PHILIP CRAVITZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 402-4788
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	14	CENSUS: 0	DATE:	05/14/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Phillip Cravitz		TIME COMPLETED:	03:20 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 May 14, 2020 at 1:30 PM., Licensing Program Analysts (LPAs) Francisco Pedroza and Francisca Velazquez conducted an announced tele-visit for the purpose of performing a pre-licensing inspection. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPAs met with applicants Phillip Cravitz and Carolyn Dallamora and discussed the nature and purpose of the visit. The tele-inspection was conducted via Zoom. During this tele-inspection the applicants took LPAs on a tour of the home. Applicant has a two story five bedroom home. The applicant will be using a living room, one bedroom, back yard, and one bathroom for day-care. The second story and garage will be off limits. LPAs did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher purchased/serviced on 5/14/2020 was observed in the entry way of the facility. Applicant is reminded to service or purchase the fire extinguisher yearly. LPAs observed the home has functioning smoke and carbon monoxide detectors in the home. LPA observed the gate that will be secured at the entry of the stairs preventing children from having access to the second story. Applicant advised to have the gate mounted prior to providing care for children. In the family room LPAs observed a fireplace with glass doors preventing children from having access. There are age appropriate toys and day-care equipment in the home. The back yard has age appropriate toys and day-care equipment. LPAs observed sufficient shade for children to have access to. LPAs advised applicant must provide visual supervision while the children are playing outside in the backyard. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2020

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: CRAVITZ FAMILY CHILD CARE	FACILITY NUMBER: 566215923
	VISIT DATE: 05/14/2020

NARRATIVE

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Family Child Care Home Orientation was completed on 12/09/2019. Preventative Health & Safety and Nutrition Training completed on 09/26/2019. Applicant Pediatric First Aid/CPR certificate is valid until 09/23/2021. Applicant AB 1207 Mandated Reporter Training Certificate expires 1/02/2020. Applicant stated they do not have firearms and ammunition in the home. Applicant advised they will have liability insurance. LPAs informed applicant they will need parents to sign a waiver for the liability insurance if a liability insurance policy is not purchased. Applicant provided mortgage statement to verify control of property. LPAs discussed and verify SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). Applicant was informed walkers, bouncers and any similar object that restricts children's movement is prohibited from licensed facilities.

LPAs reviewed, discussed and gave applicant updated samples of state required forms to be kept in the children's file, required forms to be posted and forms that need to be maintained at the Family Child Care Home (FCCH). LPAs discussed information about Sudden Infant Death Syndrome, Never Shake a Baby, and Capacity requirements. A guide to Effects of lead poisoning and Safe Sleep pamphlet was provided to applicant. Applicant was made aware that it is their responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov.

No deficiencies cited during this visit. Facility fire clearance inspection is scheduled on May 28,2020. A provisional license to operate a small Family Child Care facility is effective today 05/14/2020.

A copy of this report was reviewed and provided to the applicant. Applicant agreed to receive a copy of report via email and voiced understanding that the read receipt confirmation from email will be in lieu of her signature once she received the report.

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 Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2020

LIC809 (FAS) - (06/04)

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