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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700170
Report Date: 07/21/2021
Date Signed: 07/21/2021 04:47:54 PM

Document Has Been Signed on 07/21/2021 04:47 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:DONN FAMILY CHILD CAREFACILITY NUMBER:
197700170
ADMINISTRATOR:DONN, AMAKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 992-1401
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:22 PM
MET WITH:Donn AmakaTIME COMPLETED:
04:23 PM
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Licensing Program Analyst (LPA) Aaron Mabika conducted an unannounced Annual Random inspection at the above facility at about 2.14 PM. Upon arrival LPA was greeted by licensee, Amaka Donn. LPA was informed by Licensee no daycare services are currently being provided since last month. A copy of Child Care Facility Roster was emailed to LPA. Per Licensing Information System (LIS) all adults residing and working in the home have obtained background clearances. Per LIS, facility annual fees are current.

The home is comfortable and well ventilated. Licensee's poisons, detergent, cleaning compounds are kept upstairs in the off-limits bedroom that is blocked off by gates at the stairs and LPA observed medications and other items which could pose a danger to child are stored in the off-limits kitchen and made inaccessible to children by way of latches. LPA observed working smoke detectors (beeping with evidence of low battery. Licensee stated she has batteries and will change them ) and Carbon Monoxide, fully charged 2A10BC fire extinguisher (not fully charged, with a service date of March 16 2018) and working telephone. There are several age appropriate toys and child computers, napping cots, a play pen and a first aid kit complete with a manual on the premises. The day care takes place in family room, and front entry hallway bathroom only. Licensee is no more using Bedroom 1 for day-care and LPA observed it was locked off making it off-limit. The backyard is observed to be off-limits.

There are no bodies of water and per licensee no firearms on the premises. The licensee has current CPR and first aid that expired, 01-31-21.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
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: DONN FAMILY CHILD CARE
FACILITY NUMBER: 197700170
VISIT DATE: 07/21/2021
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Waiver form completed April 2021 and sent to RO.
The licensee has taken the mandated reporter training on 07/27/19 which is due to be renewed 07/27/2021. Licensee provides transportation and the following documentation was reviewed, as a result; The DL has an expiration date of 02/11/2025, Car Insurance expiration of 11/02/2021 and care registration expiring 12/24/2021 and a disabled person card expiring 06/30/2023.
The licensee has the required immunizations.
Incidental Medical Services (IMS) policy was discussed. Licensee states she is not providing any. 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 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

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the

DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DONN FAMILY CHILD CARE
FACILITY NUMBER: 197700170
VISIT DATE: 07/21/2021
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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 send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Per the licensee, fire and disaster drills are conducted Monthly; last drill documented and conducted on 06/10/2021. An official department log was provided to the Licensee.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394).

The following was discussed with the licensee;


No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake safety and necessity of drills (every 6 months), required forms for children’s files, facility files, posting requirements, penalty, fingerprint clearance, and the transfer process and penalty. For additional information and forms visit our website at: www.ccld.ca.gov
Licensee is aware of CCLD child care videos on Community Care Licensing website at: https://ccld.childcarevideos.org/

A type "B" deficiency was cited for the smoke detectors and the Fire extinguisher in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. The citation was downgraded to a "B" on account of the fact that licensee has not had children for a month.

An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided to the licensee.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/21/2021 04:47 PM - It Cannot Be Edited


Created By: Aaron Mabika On 07/21/2021 at 04:30 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: DONN FAMILY CHILD CARE
FACILITY NUMBER: 197700170

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2021
Section Cited
HSC
102417(g)(1)

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102417 Operation of a Family Child Care Home
The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
This requirement was not met as evidenced by the following;
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Licensee changed the smoke detector batteries before LPA left. Liicensee is goig to service the Fire Extinguisher within 24 hours and sent the evidence to RO.
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Licensee failed to service the fire extinguisher (2018 service date) and the smoke detectors were beeping as evidence of old batteries.
This poses an immediate risk to children in care. The citattion was downgraded to a "B" because the Licensee has not had children for a month.
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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:Claretta Yates
LICENSING EVALUATOR NAME:Aaron Mabika
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2021


LIC809 (FAS) - (06/04)
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