197700523-2-1-2022-12-CC-LKIG-CB8QUR-20220201112911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700523
Report Date: 02/01/2022
Date Signed: 02/01/2022 11:29:30 AM

Document Has Been Signed on 02/01/2022 11:29 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	WASHINGTON FAMILY CHILD CARE		FACILITY NUMBER:	197700523
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	02/01/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Tyeshia Washington		TIME COMPLETED:	12:00 PM

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Licensing Program Analysts (LPAs) Lady King-Lewis and Liana Stepanyan conducted a Pre-licensing Inspection with Applicant Tyeshia Washington, who guided analyst on a tour of the facility. This is a one story 3 bedroom, 2 bathroom home with living room, kitchen, dining area, attached garage and rear yard. There is no pool/spa on the premises. Family members residing in the home include 2 adults (Applicant and applicant’s spouse). Applicant stated her adult nephew no longer resides in the home and cannot return until live scan cleared. Applicant provided a written declaration, stating nephew no longer resides in the home. All adults living/residing in the home are fingerprint cleared and associated.

The Applicant stated the facility days and hours of operation will be Monday through Friday from 6:00 AM to 6:00 PM. The facility Sketch shows the daycare will take place in the living room, dining area, hallway bathroom, and rear yard of home. All bedrooms, the kitchen, laundry area in garage, and the storage shed on side rear yard are off limit to daycare children. LPAs observed locked car stored in rear yard. Applicant aware car shall be locked at all times during day care hours.

Incidental Medical Services (IMS) policy was discussed, informing applicant when any IMS is provided, a plan for providing IMS must be submitted to the Department prior to providing care to a child that need IMS. The plan shall state the type of IMS the facility will be offering, stating the person providing care has been trained to provide the named IMS. The plan will also provide the steps that will be taken when IMS is provided to a child.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

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: WASHINGTON FAMILY CHILD CARE	FACILITY NUMBER: 197700523
	VISIT DATE: 02/01/2022

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The following information regarding ADA was discuss and the following information 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

Applicant was advised 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 to the department. Applicant was informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be report on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

Physical Plant: LPAs observed day care area to be orderly and clean, fireplace screened and covered with toy chest, central air and heating, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector. Applicant will make tables against rear garage hazard free by ensuring they will not tip over a child. Shed in the rear yard shall be locked, plastic container covering a motor shall be inaccessible to children. LPAs observed 2 dogs in the rear yard in dog run area, applicant states dogs will remain in rear yard during daycare hours inaccessible to children. Applicant is aware she shall check rear yard for dog feces prior to children playing in the rear yard area.

Applicant inform smoking is prohibited, applicant stated no one smokes in the home, LPA discuss Health Section 1596.846(b) and (c)–102417 (g)(10) and provided applicant with a visual copy of prohibited items. LPA did not observe prohibited items during the inspection.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

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: WASHINGTON FAMILY CHILD CARE	FACILITY NUMBER: 197700523
	VISIT DATE: 02/01/2022

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There is a designated area for ill child(ren) as necessary, applicant stated no weapon/firearms in home, facility sketch complete showing the off limit areas. Applicant has a landline and cellphone for daycare use. Applicant was informed her cell phone shall be available and charged at all times during daycare hours. LPA observe a fully charge 2A10BC fire extinguisher during the inspection. Applicant made poisons, medication and cleaning items inaccessible to children stored in kitchen cabinet. Applicant stores medication in her bedroom inaccessible to children.

Kitchen: The following are inaccessible: Sharp items are stored on the top kitchen cabinet. LPAs observed the refrigerator and freezer to be clean. LPA discuss with applicant food shall be properly stored or refrigerated in container that are labeled with child’s name when supplied by parent.

Bathroom accessible to children: The following are inaccessible: shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover. LPAs observed a clean, safe and operable Toilet and faucet.

Outdoor: LPA observed the play area in the rear yard with age appropriate toys. No garden tools, poisonous plants, thorn trees cactus, or lawn mower accessible to children. Play area is fenced and gated all around, no body of water on the premises. Applicant states there is 2 vaccinated dogs in the rear yard inaccessible to children.

Advisory/Other: LPA observed a first Aid kit with emergency supplies. Applicant shall obtain a thermometer. Applicant provided current First Aid/CPR expires 09/2022. Preventative Health & Safety completed 12/07/2021. Electrical outlets are inaccessible to children. Children will nap on mats and crib. LPAs observed play pen in rear yard. Applicant aware no infant shall be swaddled and car seat shall not be used for sleeping. Applicant is aware to

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

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: WASHINGTON FAMILY CHILD CARE	FACILITY NUMBER: 197700523
	VISIT DATE: 02/01/2022

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supervise infants while they are sleeping by physically checking every 15 minutes and documenting the child status. Applicant should refer to regulation 102425(J) for documentation requirement. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, the provider shall return the infant to their back for sleeping. 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.

Applicant was reminded that all adults 18 and over living or working in the home, 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.

Documents Provided and or Discussed: The following were provided (via email) to comply with Title 22 requirements: Fire Drill Log, roster, Safe Sleep poster, water lead poster, required postings and list of CCL forms required for child file each child in care. LPA observed the Lead Information Flyer posted. Applicant stated she currently doesn’t have childcare insurance. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

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: WASHINGTON FAMILY CHILD CARE	FACILITY NUMBER: 197700523
	VISIT DATE: 02/01/2022

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Before licensure the following shall be completed:

Applicant shall have a thermometer in the first aid kit.

Tables in rear yard shall be made safe or removed.

Shed shall be locked and inaccessible to children.

Plastic container covering a motor shall be inaccessible to children.

During this inspection facility was observed not to be in compliance with Title 22.

Exit interview conducted and report was reviewed with the applicant Tyeshia Washington and a copy of the report was provided.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

LIC809 (FAS) - (06/04)

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