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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700623
Report Date: 09/15/2022
Date Signed: 09/15/2022 12:35:04 PM

Document Has Been Signed on 09/15/2022 12:35 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:BROWN FAMILY CHILD CAREFACILITY NUMBER:
197700623
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
09/15/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Natalie BrownTIME COMPLETED:
12:49 PM
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Licensing Program Analyst (LPA) Justin Dorsey conducted an announced visit with Applicant Natalie Brown who guided analyst on a tour of the facility for a Pre licensing Inspection. This is a one story home with 4 bedrooms, 3 bathrooms, kitchen, dining room, living room, attached garage and detached garage. There is a pool/or body of water on the premises. Family members residing in the home include two adults (including applicant) and one family member. Days/hours of operation will be Monday through Friday from 08:00 AM to 06:00 PM.

Physical Plant: On limit areas in the home include the living room, kitchen, dining room, one of the homes bathrooms and detached garage. LPA observed there was a functioning bathroom in the detached garage. Off limit areas include all of the homes bedrooms and attached garage. Due to the detached garage not having a certificate of occupancy, LPA Dorsey advised applicant that main care can not be provided in the detached garage. LPA Dorsey advised applicant to move all napping equipment so that children can nap in the homes living room. LPA observed a operable smoke detector and fully charged 3A10BC fire extinguisher in the detached garage. LPA Dorsey advised licensee to get a carbon monoxide detector for the detached garage. Home is clean and orderly, there are two fire places in the home which have been barricaded. LPA observed age appropriate toys and play equipment, working smoke detector and carbon monoxide detector in the home. Per applicant no one smokes in the home. There is a designated area for ill child(ren) as necessary, LPA Dorsey observed the homes firearm and ammunition was stored properly, facility sketch complete and current. There is a working telephone (cell), poisons and cleaning items inaccessible (locked in kitchen and detached garage cabinets) to children.

Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Sharp items, medications (inaccessible in top kitchen cabinet) and chemicals (locked under sink) are inaccessible. Toilets and faucets are clean and operable.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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: BROWN FAMILY CHILD CARE
FACILITY NUMBER: 197700623
VISIT DATE: 09/15/2022
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Outdoor: LPA Dorsey observed the homes backyard. The homes backyard is divided into 3 areas. The first area is a completely fenced on limit area between the home and the detached garage which includes concrete and grass for children to play. LPA Dorsey observed this area has a wood jungle gym with swings and toys for the children to play. LPA observed the on-limits outdoor play area toys and equipment to be in good condition. LPA did not observe any items that could be hazardous to children in in the on-limits play area. The second part of the backyard is a pool that is completely fenced by a brick wall with 3 gates that swing away form the pool. The pool can be accessed by three gates (one located in the children's play area) in the backyard, 2 sliding glass doors in the home (both doors have alarms) and 1 window in the home. LPA Dorsey advised licensee that a waiver will be needed for the homes pool. The last part of the homes backyard is a fully fenced dirt area that surrounds both the pool and the children's outdoor play area. In this area there is a covered metal hanger, shed, storage container, gym, chicken area/coup and garden area. Per applicant the only time children will access this area will be when they are supervised feeding the chicken and ducks in the chicken area/coup.

Advisory/Other: First Aid kit readily available. CPR/First Aid expire 04/30/2024. LPA Dorsey observed 2 cribs for children/infants to nap. According to the applicant she will order mats/cots when children begin to enroll at the home. Per licensee the children will nap in the living room area in the home. LPA reminded applicant to supervise children at all times.

Pets: Per applicant there are 3 dog, 2 cats, a snake, a lizard, chicken and ducks in the home and backyard.

LPA Dorsey advised Applicant All adults living/residing in the home are fingerprint cleared and associated.

Documents Provided and or Discussed: The following were discussed regarding LIC 311D, LIC 9227, IMS Guide, Infant Sleep Log, Title 22 requirements: Safe Sleep and Small Family Child Care Home Ratios

Incidental Medical Services (IMS) policy was discussed. 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

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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: BROWN FAMILY CHILD CARE
FACILITY NUMBER: 197700623
VISIT DATE: 09/15/2022
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The following was discussed with the Applicant:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Applicant reminded that 100% supervision is required at all times to children in care; Applicant made aware that it is her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

Applicant advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Applicant advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 3 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: BROWN FAMILY CHILD CARE
FACILITY NUMBER: 197700623
VISIT DATE: 09/15/2022
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Corrections needed:
1.) Applicant will move all cribs from the detached garage to the homes living room.
2.) A cover plate will be place on the outlet in the detached garage near the restroom.
3.) Carbon monoxide detector will be placed in the detached garage.
4.) The back pool gate must self close and latch.

Exit interview conducted and a copy of this report was given to Applicant Natalie Brown.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4