197495250-4-13-2023-30-CC-ARIR-CQUNHE-20230413102837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495250
Report Date: 04/13/2023
Date Signed: 04/13/2023 10:28:50 AM

Document Has Been Signed on 04/13/2023 10:28 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:	MCDONALD FAMILY CHILD CARE		FACILITY NUMBER:	197495250
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	04/13/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Keywonda Mcdonald, Applicant		TIME COMPLETED:	10:35 AM

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 04/13/2023 , Licensing Program Analyst (LPA), Adrian Risher conducted a pre-licensing inspection for a family child care home. LPA met with applicant Keywonda Mcdonald 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 6:30am to 6pm Monday thru Friday. Applicant is requesting to have a family child care home with a capacity of 8.

The single family home has 2 bedrooms and 2 bathrooms. The daycare will consist of the family room. These areas were inspected by LPA. The other bedrooms and rooms are considered off-limits and inaccessible. Applicant is renting the home. Applicant provided property owner/landlord consent form with the application.

The family room will be used for daily activities, eating and sleeping. Applicant stated the children will have access to the garage for play time and learning. LPA observed cots that will be used 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.

Applicant will use a cot in the family room for ill children.

LPA observed age appropriate toys, furniture and activities for children while in care at the facility. The outside play area will be in the back of the home. There are no bodies of water. The outside play area is fenced all around.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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: MCDONALD FAMILY CHILD CARE	FACILITY NUMBER: 197495250
	VISIT DATE: 04/13/2023

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
26
27
28
29
30
31
32

LPA observed a charged fire extinguisher (2-A:10-B:C). LPA tested the smoke detector and carbon monoxide detector. All electrical outlets are inaccessible to children. Applicant has a first aid kit which includes band aids and a thermometer. The home has central heat and air

Applicant has current CPR, first aid, health and safety which expires 02/2025. Mandated reporter training was completed in 02/2023. Applicant provided copies of immunization record.

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.

A license to operate a Small Family child care home will be reviewed following final administrative review and receipt of outstanding corrections needed. No license will be issued today 04/13/2023. Applicant will notify LPA when corrections have been made and the Applicant has 30 days to complete corrections.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

Page: 2 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: MCDONALD FAMILY CHILD CARE	FACILITY NUMBER: 197495250
	VISIT DATE: 04/13/2023

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
26
27
28
29
30
31
32

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Keywonda Mcdonald

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3