197700589-8-1-2023-12-CC-JTAO-CUASNK-20230801140139

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700589
Report Date: 08/01/2023
Date Signed: 08/01/2023 02:01:46 PM

Document Has Been Signed on 08/01/2023 02:01 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 CARE		FACILITY NUMBER:	197700589
ADMINISTRATOR:	WYVONNEA ALLEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 406-7968
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	08/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Wyvonnea Allen, Licensee		TIME COMPLETED:	02:15 PM

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 08/01/2023, Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee, Wyvonnea Allen, who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 4 bedroom, 2 bathroom home with kitchen/dining, living room, family room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 1 infant and 1 school age child in care. Family members residing in the home include 1 adult (licensee) and no minor children. Facility operation are Monday-Friday 4AM-7PM. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Main care is provided in the family room. Children use the bathroom in hallway on the right hand side. Children have access to the living room and front yard area. Off limit areas include all bedrooms, bathroom #2, laundry room, and garage. LPA observed a safety gate barricading the rest of the off limit areas. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (in laundry room barricaded by safety gate), medicines (master bathroom(key lock door knob)) and hazardous items (sharp knives on top of refrigerator unreachable to children in care) that can pose a danger to children. LPA observed a fireplace in the living room barricaded. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary near the front entrance. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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 4

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: 08/01/2023

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

Documents Provided and or Discussed: LIC311 D Forms to Keep in Your Family Child Care Home, Safe Sleep PIN 20-24-CCP, Safe Sleep Log, and Individual Sleeping Plan (LIC9227).

Licensee Allen 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.

LPA discussed the safe sleep regulations with licensee Allen 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 licensee 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.

Exit interview conducted and report was reviewed with the licensee Wyvonnea Allen, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 08/01/2023

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

Fire/earthquake drills are maintained current. Last fire/disaster drill was completed on 06/16/2023.

Roster complete and maintained current.

During children's file review, child #1 and child #2 did not have proof of immunization's with poses a potential risk to children in care. Facility has been cited a Type B Citation. Please see LIC809-D for deficiency page.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: At this time, kitchen area is currently under construction due to water leak. Licensee has submitted LIC624 Unusual Incident Report to Licensing. Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Breakfast, lunch, snacks and dinner are provided. Naps are provided in the main care area.

Outdoor: The front yard is safe for children. The front yard is completely fenced. There is no body of water. Licensee shall ensure the front gate remains closed at all times during operation hours. LPA observed age appropriate toys.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expires 02/28/2024. Mandated Reporter expires 02/15/2024. There are no window cords accessible to children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 08/01/2023 02:01 PM - It Cannot Be Edited

Created By: Justeene Tamayo On 08/01/2023 at 01:42 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: ALLEN FAMILY CHILD CARE	FACILITY NUMBER: 197700589
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Child #1 and Child #2 did not have proof of immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/01/2023
	Plan of Correction
1 2 3 4	Licensee will ensure she obtains proof of immunizations for each child enrolled in care. Licensee will send proof of immunizations to LPA Tamayo no later than 09/01/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Mariela Ramon

LICENSING EVALUATOR NAME:

Justeene Tamayo

LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4