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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418896
Report Date: 06/28/2022
Date Signed: 06/28/2022 03:46:10 PM

Document Has Been Signed on 06/28/2022 03:46 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:HOWARD FAMILY CHILD CAREFACILITY NUMBER:
197418896
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
06/28/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Edna HowardTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lady King-Lewis conducted an unannounced prelicensing inspection for the purpose of an increase of capacity from an 8 Family Child Care Home(FCCH) to a 14 FCCH. LPA was greeted by licensee Edna Howard who guided the LPA on a tour of the Family Child Care Home. Upon arrival 5 children (7, 4(4), and 3 years of age, were in care. Licensee is aware an assistance must be present when more than 8 children are in care.

The day care take place in the following area of the home: playroom/living room, formal dining room, family room, kitchen table area, hallway bathroom, and rear-yard. The off limit areas for the day-care are all bedrooms and garage. There is no pool/spa on the premises. Family members residing in the home include two adults (Licensee and spouse and two minor children). Days/hours of operation will be Monday through Friday 6:00 AM to 6:00 PM.



The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating (central) and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items (sharp knives stored in high cabinet) that can pose a danger to children.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197418896
VISIT DATE: 06/28/2022
NARRATIVE
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Per Licensee there are no weapons or firearms on the premise. LPA did not observe any weapons in the home. There are age appropriate toys. Age appropriate napping equipment (cots). The required fire extinguisher (2A10BC) and smoke detector are in operable condition. The home has a Carbon Monoxide detector. Fireplace is screened (Family Room). Home has central AC and heat.

Licensee is aware of the following:


Capacity requirements, Notification of Parent's Rights, Roster requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, Safe Sleep Regulation. The role and responsibilities of being a mandated reporter were reviewed. LIC311D was provided.

Licensee is aware that all employees or volunteer at the day-care shall be fingerprint clearances and associations to Licensee day care facility, provide a cleared TB test result, be immunized against pertussis, measles and maybe immunized against influenza. Licensee is aware personnel shall complete training on preventive health practices including CPR and first aid if licensee will be leaving personnel at the facility alone.

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B per the regulation.

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
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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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: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197418896
VISIT DATE: 06/28/2022
NARRATIVE
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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.html

During this inspection LPA observed the off limit area of the home, accessible to children in care and the air conditioner in rear yard shall be covered to prevent hazard. The application for a Large Family Child Care Home with a maximum capacity of 0012 or 0014 with parent is notified is not in compliance with Title 22 regulations. Mrs. Howard will make the corrections documented on the LIC 809D before the licensee can care for a maximum capacity of 0012 or 0014 with parent notification, can be submitted for approval.

An exit interview was conducted, and a copy of this report was provided to the licensee on this date.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/28/2022 03:46 PM - It Cannot Be Edited


Created By: Lady King On 06/28/2022 at 02:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197418896

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2022
Section Cited
CCR
102416.3(a)(6)

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Alterations to Existing Buildings or Grounds (a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:
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Licensee stated she will find and install a Kiddy gate and provide proof that a secured gate is in place to prevent access to off limit area of the home from children in care.
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This requirement was not met by evidence that LPA did not observe any barricade to prevent the children in care from having access to the bedrooms and garage of the home that the licensee states is an off limit area for day care children.
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Type B
06/28/2022
Section Cited
CCR102417(g)

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: rear yard air conditioning unit shall be inaccessible to children.
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Licensee stated she will make the air conditioner's blades inaccessible to children in care.
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 This requirement was not met as evidence by LPA observed rear yard air conditioning unit accessible to children in care, could case potential hazard.

No children was outside playing during this inspection.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Lady King
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022


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