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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700738
Report Date: 09/07/2023
Date Signed: 09/07/2023 12:44:36 PM

Document Has Been Signed on 09/07/2023 12:44 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:COLLINS FAMILY CHILD CAREFACILITY NUMBER:
197700738
ADMINISTRATOR:JOCELYN COLLINSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 300-0163
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/07/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Jocelyn Collins, Applicant TIME COMPLETED:
01:30 PM
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On 09/07/2023 Licensing Program Analyst (LPA) Justeene Tamayo conducted a Pre-licensing Inspection with Applicant Jocelyn Collins, who guided LPA on a tour of the facility.

This is a two-story house with 5 bedrooms, 3 bathrooms, living room, dining room, kitchen, laundry room area and garage. There is also backyard fully barricaded by cement blocks. Family members residing in the home include 2 adults (Applicant and applicants adult daughter) and four minor child. All adults have been fingerprint cleared and associated. LPA did not observe a swimming pool or bodies of water on the premises.

The facility will operate Monday through Friday from 6AM-6PM for less than 24 hours and with a license capacity of 14 children. LPA 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, bedroom #1, and dining room area. Children will eat in the dining room area. Per applicant, she will be utilizing a food program. The day care children will utilize the hallway bathroom on the left hand side near bedroom #1. The front yard, backyard, entire upstairs (barricaded by safety gate), bedrooms #2-4, bathrooms #2-3, laundry room (barricaded by safety gate), and garage(key lock door knob) are off limits to the day care children.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700738
VISIT DATE: 09/07/2023
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LPA observed day care area to be clean and orderly. LPA did not observe a fireplace in the home. There is central air and heating, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector.

LPA did not observe any hazardous items in the child care bathroom. Applicant safety latched the cabinets under the bathroom sink. LPA reminded applicant the children's bathroom must be free of shampoos, mouthwash, medication, perfumes, razor, air freshener, nail polish and polish remover. LPA observed a clean, safe and operable toilet and faucet.

LPA observe a fully charged 2A10BC fire extinguisher during the inspection located in kitchen area. Per applicant no alcohol is present in the home. First aid kit is stored near the kitchen area. LPA observed medications to be stored in the upper kitchen cabinet with safety latch.

Applicant made poisons and cleaning items inaccessible to children stored under the kitchen sink with a safety latch.

Kitchen: The following are inaccessible: Sharp items are stored in the upper kitchen cabinet unreachable to day care children in care. LPA 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. Applicant currently has a food program.

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

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700738
VISIT DATE: 09/07/2023
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LPA toured the backyard and observe it to be free of garden tools, poisonous plants, thorn trees cactus, or lawn mower inaccessible to children. The backyard is completely gated. At this time, the backyard is currently off limits to day care children. LPA observed an outdoor air-conditioner completely barricaded with mesh covering. Applicant states there are two dogs in the home. LPA obtained vaccination records for the two dogs.

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, LIC9227 Individual Sleeping Plan, Safe Sleep log, required postings, and list of CCLD forms required for child file each child in care (LIC 311D). Applicant stated currently has childcare insurance. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

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

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700738
VISIT DATE: 09/07/2023
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Applicant inform smoking is prohibited, applicant stated no one smokes in the home, LPA discussed 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. 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: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: COLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197700738
VISIT DATE: 09/07/2023
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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: 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 areas. 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. LPA 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. 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 is ready for 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: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC809 (FAS) - (06/04)
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