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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494917
Report Date: 08/19/2021
Date Signed: 08/19/2021 09:13:40 AM

Document Has Been Signed on 08/19/2021 09:13 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DAVIS FAMILY CHILD CAREFACILITY NUMBER:
197494917
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/19/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:20 AM
MET WITH:Tomicia Davis ApplicantTIME COMPLETED:
09:30 AM
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On 08/19/2021 7:20am, Licensing Program Analyst (LPA) Adrian Risher conducted a pre-licensing inspection for a family child care home relocation. LPA met with applicant Tomicia Davis at 7:25AM and toured the facility. The applicant is the only individual present at the time of the inspection. LPA did not observe any children present. The home is clean, orderly and comfortable. All adults in the home have been fingerprinted and associated to the facility. The hours of operation will be 7:00AM TO 6:00PM Monday thru Friday. Applicant is requesting to have a family child care home with a capacity of 8.

This single family home has 3 bedrooms and 2 bathroom house. The day-care will consist of the living room, dining room and bathroom 1. These areas were inspected by LPA. The other bedrooms and rooms are considered off-limits and inaccessible. Applicant has safety handles on the doors of the rooms that are off-limits to the children in care. Applicant is renting the home. Applicant provided property owner/landlord consent form with the application. The parents will enter home from the front entrance.

Applicant stated the living room will be used for daily activities, napping and eating. LPA observed 2 playpens that will be used for napping infants. Applicant will use mats for napping. LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected during the visit. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. These items were made inaccessible to the children. LPA observed the sharp knives stored on top of the refrigerator. LPA observed a safety gate at the entrance of the kitchen. Applicant stated that cleaning supplies and sanitation supplies are stored in the linen closet in the hallway. Applicant will place a safety handle on the door of the linen closet. LPA observed a blanket placed near the front door of the home which will be used as the isolation area for ill children.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 197494917
VISIT DATE: 08/19/2021
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The following was discussed with the applicant:

LPA discussed Safe Sleep Regulations with licensee.

Applicant was made aware that once licensed, it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Applicant was also encouraged to read the Child Care quarterly updates to remain informed of any changes or updates to the Regulations.

At this time, the facility does not provide Incidental Medical Services - IMS.

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. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 197494917
VISIT DATE: 08/19/2021
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LPA inspected the outside of the home and observed age appropriate toys/equipment. The outside play area is gated all around. Applicant will have the children come from the front entrance of the home and walk down the driveway to gain access to the outside playarea. There is no body of water at home.

LPA observed a charged fire extinguisher (2-A:10-B:C). LPA tested the smoke detector and carbon monoxide detector. LPA observed the electrical outlets covered. Applicant has a first aid kit which includes band aids and a thermometer. Applicant stated that she will use a portable fan in the warm weather and a portable heater during the cold weather. Applicant will open the windows in the day-care rooms if needed. Applicant stated she will warm up the home prior to the children arriving at the day-care.

Applicant has current CPR, first aid, health and safety which expires 05/20/2022.


LPA received copies of immunization records and mandated reporter training. These documents were provided with the application. Per the applicant, there are no firearms on the premises. Applicant reports that there are no pets in the home. . LPA did not observe any baby walkers, exersaucers or bouncers.

The parent board will be posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible.


NO corrections needed today

A license to operate a Small Family child care home will be reviewed following final administrative review. No license will be issued today 08/19/2021.

Exit interview and copy of report provided. Appeal rights have been reviewed and provided
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
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