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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017999
Report Date: 07/10/2024
Date Signed: 07/10/2024 03:23:47 PM

Document Has Been Signed on 07/10/2024 03:23 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KUYPER FAMILY CHILD CAREFACILITY NUMBER:
198017999
ADMINISTRATOR/
DIRECTOR:		KUYPER, REBECCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 370-4841
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
07/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:REBECCA KUYPER, Licensee TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. Upon arrival LPA met with Rebecca Kuyper, Licensee, who provided tour of facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Licensee provides care to children ages newborn to 12 years old and operates Monday through Friday 6:00AM to 6:00PM. There were 7 children present, including 1 infant. Also present was Rhiannon Polk, Assistant. All adults present have been cleared and associated. Individuals residing in the home were discussed and noted.

This is a one-story home which consists of three bedrooms, two bathrooms, kitchen, living room, den (Daycare Room), garage, front yard (not fenced) and backyard (fenced).

Areas accessible to children in care include the living room, kitchen, two bedrooms, den (Daycare Room) and backyard. The bedroom that leads to the Daycare Room is used as a pass through.

Areas off limits to children include 1 bedroom, 1 bathroom, garage, dog run (fenced next to yard) The children use the bathroom in the hallway. Bathroom was observed to be safe and sanitary.

Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation, and heating. Rooms that are off-limits need to be made inaccessible during operating hours. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted at entrance to home in prominent location. Licensee was reminded to ensure the forms are not be be covered by other forms. LPA reviewed completed facility records including LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.


LPA provided an updated PUB 394 and an LIC 610 Emergency Disaster Plan for Family Child Care.

Page 1 – Report Continues
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KUYPER FAMILY CHILD CARE
FACILITY NUMBER: 198017999
VISIT DATE: 07/10/2024
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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was purchased on 07/2023, Licensee was reminded that fire extinguisher needs to be serviced/purchased yearly. The home maintains telephone service via cell phone line. The home is observed to be clean and orderly. There are age appropriate toys and material available. LPA observed that cleaning compounds are in kitchen and Daycare Room inaccessible to children in care. The bathroom that children use is in the hallway by living room and observed to be clean and free of hazards.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home.


Isolation area for sick children waiting to be picked up is in the living room, supervised and away from the other children.

LPA discussed the safe sleep regulations, with licensee 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.

Children using the back yard for outdoor play. LPA observed a boat stationed on one side of the yard, the metal hitch which might pose a hazard if accessed to children was covered with a tarp.


WATER PLAY: LPA observed a kiddie Pool 21 inches in height filled with 14 inches of water, Per licensee, the pool os used by children 3 years and older, there is one adult who is CPR/1st Aid certification always present during water play. An Additional staff is always present supervising younger children. The licensee provided a written plan of supervision for when children are using the kiddie pool.

The outdoor play area was observed to be fenced with an additional separated area used as a dig run. LPA observed that the outdoor yard has toys and other materials for children to play with including a two-level wooded and plastic play structure, which is anchored to the ground with cushioned material under structure. The facility does not have a fixed swimming pool, spa or similar bodies of water.
LPA observed 1 small dog the home, that interacts with children with supervision.
-------------------Page 2 – Report Continues
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KUYPER FAMILY CHILD CARE
FACILITY NUMBER: 198017999
VISIT DATE: 07/10/2024
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Children’s records were reviewed, Child #1, a 10-month old infant is missing the required Infant Sleep Plan LIC 9227 and Immunization record. Staff records were reviewed. The licensee and staff have not completed the required Mandated Reporter Training, posing a potential risk to the health and safety of children in care. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders (RSO) living in the facility and LPA completed the RSO search in Megan’s Law Website.

A notice of site visit was given and must remain posted for 30 days.Exit interview conducted and report was reviewed with the licensee Rebecca Kuyper. Appeal Rights were provided.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/10/2024 03:23 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 07/10/2024 at 02:31 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KUYPER FAMILY CHILD CARE
FACILITY NUMBER: 198017999

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that 2 out of 2 staff did not have the Mandated Reporter Trainng Certificate on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/24/2024
Plan of Correction
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Per licensee, the Mandated Reporter, General and Child Care Provider will be completed and a copy of the cerificate will be sent to LPA by POC due date.
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
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Based on record review, the licensee did not comply with the section cited above in [count] out of 1 out of 4 children's files did not have record of immunizations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/24/2024
Plan of Correction
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Per licensee, the immunizations for Child #1 will be obtained and a copy will be sent to LPA by POC due date.
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 07/10/2024 03:23 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 07/10/2024 at 02:31 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KUYPER FAMILY CHILD CARE
FACILITY NUMBER: 198017999

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out 1 infant under 12 months of age did not have an LIC 9227 Infant Sleep Plan which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/24/2024
Plan of Correction
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Per licensee, the infant sleep plan will be completed and a copy will be sent to LPA via email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


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