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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417757
Report Date: 09/04/2024
Date Signed: 09/04/2024 03:13:22 PM

Document Has Been Signed on 09/04/2024 03:13 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KELLY FAMILY CHILD CAREFACILITY NUMBER:
197417757
ADMINISTRATOR/
DIRECTOR:		KELLY,BARBARA & LEOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 940-3366
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:03 PM
MET WITH:Barbara KellyTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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On 9/4/2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced annual/random inspection at Kelly Family Child Care. Upon arrival, LPA Heath met with the licensee, Barbara Kelly, who provided a facility tour. The home is occupied by two adults (the licensee and her husband) and two children (The daughter is 19 in college and 14 years old). 10 young children and one infant (4 months) were present during the inspection. The licensee stated that the facility operates Monday through Friday, from 6:30 a.m. to 5:00 p.m. Incidental Medical Services (IMS) were discussed, and the licensee confirmed that no children require IMS.
This is a two-story, four-bedroom, three-bath home with a kitchen/dining room, family room, living room, laundry room, and garage. There is no pool/spa or body of water on the premises. The home was inspected for safety, comfort, cleanliness, telephone service, and ventilation. It has central heating and air conditioning, and all windows have screens free of cracks, bugs, and debris.
Main Area: Main care is provided in the living room and dining area. Children use the bathroom in the hallway on the left. Children have access to the living room and dining room area. Off-limit areas include all bedrooms, bathrooms #2 and #3 (upstairs), laundry room (with key lock), and garage (has a key lock door knob).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 09/04/2024
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Living Room / Dining area: LPA observed age-appropriate toys and furniture in the designated childcare areas. There is a child-size table and chairs and several plastic storage bins containing games and toys for the children. The facility also has games and books available. Mats with educational and learning activities are on the floor and were noted to be in good condition. An adult-size couch is present, and a TV is used to play educational videos for the children.
Children's Bathroom (#1): The bathroom was inspected, and the sink and toilet are operable. The toilet and faucets are clean and safe. The medication cabinet is free of medications or personal items, and all poisons and medications are secured with child safety latches under the sink cabinet. The bathroom was found to be clear of any hazardous items.
Kitchen: The kitchen was inspected for safety, and it was noted that hazardous items are kept out of children's reach with child safety latches. Sharp utensils, poisons, and medications are not accessible to children, and sharp knives are stored in a butcher block.
Backyard: The backyard was inspected. The children use the outside backyard for outside play. The backyard is gated all around. The outdoor play area was observed to be free of hazards and loose and sharp parts. Two outdoor air conditioners are inaccessible to children, with barricaded gates around them. LPA observed age-appropriate toys and covered the barbecue pit. LPA observed one dog on the premises.
Others:
AC/Heating Unit and Swamp Cooler Unit: The AC/Heating Unit, located on the right side of the home, is inaccessible to children due to barrels blocking access.
Bodies of Water: According to the licensee, there are no bodies of water in the home.
Electrical Outlets: All unused electrical outlets are covered and inaccessible to children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 09/04/2024
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Fire Extinguisher (2A10BC): A fire extinguisher rated 2A10BC, reading in the green zone, is located in the kitchen and is inaccessible to children. It meets the standards set by the State Fire Marshal.
Hanging Window Blind Cords: The LPA reminded the licensee that window blind Cords should be kept out of the reach of children.
Isolation Area (Illness): If a child shows signs of illness, they will be separated from other children and stay near the front door.
Medications and Cleaning Solutions: Detergents and cleaning compounds are stored in an upper kitchen cabinet, while medications are kept in an off-limits bedroom.
Napping: Children nap in designated areas with adult supervision. Ten mats were observed in the closet for napping.
Overnight Care: The licensee does not provide overnight care.
Pets: There is 1 dog with current vaccinations.
Phone Service: A working landline or cell phone is available.
Smoke Detectors and Carbon Monoxide Detectors: Both smoke and carbon monoxide detectors were tested and are operational.
Stairs (For Two-Story Homes): A safety gate is installed to ensure the stairs are inaccessible to children.
First Aid Kit: The kit is stored in a key-locked closet and includes supplies and a manual.
Transportation: The licensee does not provide transportation for children.
Weapons or Firearms: Per the licensee, there are No Firearms at the facility at this time. LPA does not observe any firearms.
Documentation:
Child files: LPA reviewed 4 children's records. The records contain all required licensing documents.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 09/04/2024
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Infant Sleeping Plan (LIC 9227) and Sleeping Log: LPA observed that 1 infant has LIC 9227, and the sleeping log is also in each infant's file; the license follows the Safe Sleep Regulation.
Staff Personnel File: During an annual inspection on 10/13/23 at 12:33 p.m., LPA observed one staff information. LPA observed LIC 508, 9052, IZ, TB test, LIC 9108, Mandated Reporter Training, and CPR/First Aid certificates. The file contained all required licensing documents.
Immunization: The licensee and her assistant have the required immunizations (MMR and DTaP). They also provided a written statement declining the influenza vaccination.
Criminal Record: Per Guardian, all adults who live in this facility obtain a criminal record clearance.
CPR/First Aid: LPA observed that the licensee has current pediatric CPR and first aid training.
Mandated Reporter Training: The licensee must complete and renew the online mandated reporter training at www.mandatedreporterca.com by 9/5/2024.
Facility fees: Per the Licensing Information System, annual facility fees were current.
Fire Drill and Disaster Drill: Per the licensee, fire, and disaster drills are conducted every six months; the last drill was documented and performed on 8/13/2024.
LPA observed that the licensee post the Facility License, Emergency Disaster plan, Earthquake Preparedness, and Parents' Rights Poster as required.

The following information was discussed with the licensee:
o A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code sections 1596.848(b) and (c). State law prohibits baby walkers, bouncy seats, exersaucer, and other items that fall into that category.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 4 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 09/04/2024
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o Capacity requirements, Roster requirements, Posting requirements, and Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children's and provider's files and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. The licensee was reminded that supervision is always required for children in care.
o The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B
o Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates on courses and updates/changes to the regulations. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that the inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility's phone number; if the phone number is changed, licensing must be notified.
o Mandatory Forms for the children's files and provider's files.
o Our Quarterly updates come out every 3 months. They are also now in Spanish. Please log in to the CCLD website, or you can email our advocates to have the quarterly updates sent directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
o Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
o Requirements for fire drills, earthquake drills, and documentation for both.
o The Duty Worker is available for questions Monday through Friday at (661) 202-3318 from 8:00 a.m. - 5:00 p.m.
o The licensee is reminded that 100% supervision is required for children at all times.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 5 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 09/04/2024
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o The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also, call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
o The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family childcare home where children are present (24/7 ban).
ü LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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.
ü Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 09/04/2024
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ü IF A FACILITY IS CURRENTLY PROVIDING IMS, USE AS FOLLOWS: 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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/
ü IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.
ü Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
ü Family Child Care Homes During the exit interview, the LICENSEE ****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
ü Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 09/04/2024
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ü To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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-carelicensing/ inspection-process.


No deficiencies are being cited at this time.

An exit interview was conducted, and the report was reviewed with the licensee, Barbara Kelly.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
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