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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700589
Report Date: 07/06/2022
Date Signed: 07/06/2022 04:45:04 PM

Document Has Been Signed on 07/06/2022 04:45 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:ALLEN FAMILY CHILD CAREFACILITY NUMBER:
197700589
ADMINISTRATOR:WYVONNEA ALLENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 406-7968
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/06/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Wyvonnea AllenTIME COMPLETED:
11:50 AM
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On 07/06/2022 Licensing Program Analysts (LPAs) Justeene Tamayo and Barbara Beneroso conducted a Pre-licensing Inspection with Applicant Wyvonnea Allen, who guided LPAs on a tour of the facility.

This is a one-story house with 4 bedrooms, 2 bathrooms, living room, kitchen, laundry room area and garage. There is also a spacious backyard with gate barricading the play area. Family members residing in the home include 1 adult (Applicant and 1 minor child). During pre-licensing inspection, LPAs observed adult #1 in the home. Per applicant, adult #1 may stay during operation hours. LPAs reminded applicant adult #1 must be fingerprint cleared and associated before day care children are present in the home.

The facility will operate Monday through Friday from 5 AM-7PM for less than 24 hours and with a license capacity of 14 children. LPAs went over the child care ratios for a large family home with applicant, and provided applicant a copy.

Main care will be provided in the living room area. Children will eat in the living room area. Per applicant, she will be utilizing a food program. The day care children will utilize the hallway bathroom on the right hand side. Children will use rear yard for outdoor play. The front yard, all bedrooms, laundry room, and garage area are off limits to the day care children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2022
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: ALLEN FAMILY CHILD CARE
FACILITY NUMBER: 197700589
VISIT DATE: 07/06/2022
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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 reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

Advisory/Other: LPAs observed a first Aid kit with emergency supplies and a thermometer on top of the cabinet in the kitchen area. Applicant First Aid/CPR are current. Preventative Health & Safety training is completed. Electrical outlets are inaccessible to children. Children will nap on cots in the main care area. Applicants aware no infant shall be swaddled, and car seat shall not be used for sleeping. Applicant is aware to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the infant’s 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. LPAs discussed the safe sleep regulations with applicant, including Safe Sleep PIN 20-24-CCP 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. LPAs 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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: ALLEN FAMILY CHILD CARE
FACILITY NUMBER: 197700589
VISIT DATE: 07/06/2022
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Applicant inform smoking is prohibited, applicant stated no one smokes in the home, LPAs discussed Health Section 1596.846(b) and (c)–102417 (g)(10) and provided applicant with a visual copy of prohibited items. LPAs did not observe prohibited items during the inspection. Per applicant no firearms are present in the home. Applicant was informed her cell phone shall be available and charged at all times during daycare 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.

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

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
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: ALLEN FAMILY CHILD CARE
FACILITY NUMBER: 197700589
VISIT DATE: 07/06/2022
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LPAs observed day care area to be clean and orderly, fireplace screened in off limit area with gate barricaded, central air and heating, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector.

LPAs observed applicant remove all shampoos from the child care bathroom and move the items to her master bedroom. LPAs reminded applicant the children's bathroom must be free of shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover. LPAs observed a clean, safe and operable toilet and faucet.

LPAs observe a fully charge 2A10BC fire extinguisher during the inspection located in kitchen area. Per applicant no alcohol is present in the home. First aid kit is also stored on the top of the cabinet near the kitchen. LPAs did not observe any medications in the home, but applicant plans on keeping medications in the upper kitchen cabinet inaccessible to children in care.

Applicant made poisons and cleaning items inaccessible to children stored in laundry room (off limits). Day care children cannot access the laundry room by the barricaded gate in the main care area.

Kitchen: The following are inaccessible: Sharp items are stored on top of the refrigerator unreachable to children in care. LPAs observed the refrigerator and freezer to be clean. LPAs discuss with applicant food shall be properly stored or refrigerated in container that are labeled with child’s name when supplied by parent. Applicant plans to have a food program.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: ALLEN FAMILY CHILD CARE
FACILITY NUMBER: 197700589
VISIT DATE: 07/06/2022
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LPAs toured the spacious backyard and observe it to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children. Per applicant the backyard is 2 and a half acres. The backyard is gated by a chain link fence. LPAs also observed a blue barn and blue garage area in the off limit areas behind the chain link fence The BBQ pit is located outside in the backyard uncovered, however applicant will move the BBQ pit to the garage (off limit) area. Applicant states there are no animals in the home.

LPAs observed an in ground swimming pool barricaded with a chain link fence at 5 feet 1 inches high. The chain link fence has a master lock and swings away from the swimming pool. LPAs observed the swimming pool to be empty at the time of the inspection. Per applicant, the maintenance workers are still working on fixing the in ground swimming pool. LPAs also observed an above ground swimming pool on the other left side of the barricaded chain link fence. The above ground swimming pool is in the off limit areas (barricaded by chain link fence) in the backyard and is currently empty. Per applicant, she will not be utilizing the above ground swimming pool. Day care children will only have access to the back yard area within the barricade of the chain link fence.

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 to comply with Title 22 requirements: Fire Drill Log, roster, Safe Sleep PIN 20-24-CCP, water lead poster, required postings and list of CCLD forms required for child file each child in care (LIC 311D). Applicant stated currently does not have childcare insurance, but plans to. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: ALLEN FAMILY CHILD CARE
FACILITY NUMBER: 197700589
VISIT DATE: 07/06/2022
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LPAs are currently waiting for proof of control of property. Applicant will send a copy of the rental agreement or lease to LPA Tamayo once received from renter. LPAs will also consult with LPM for approval of licensure.

Exit interview conducted copy of this report was provided to applicant along with notice of site visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022
LIC809 (FAS) - (06/04)
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