198400406-11-9-2022-54-CC-AMOY-CL289B-20221109211851

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400406
Report Date: 11/09/2022
Date Signed: 11/09/2022 09:19:02 PM

Document Has Been Signed on 11/09/2022 09:19 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:	OLIVER FAMILY CHILD CARE		FACILITY NUMBER:	198400406
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 3	CENSUS: 2	DATE:	11/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Mia Oliver, Licensee		TIME COMPLETED:	04:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Alicia Mooberry conducted Required Annual inspection for the above address. LPA met with Mia Oliver, Licensee and provided the inspection Entrance Checklist, LIC 126. Licensee provided tour of facility. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Upon arrival at 2:15pm LPA observed 2 child with license. Per licensee the hours of operation are Monday-Friday 6:30am-6:00pm. After hour care is provided as needed. LPA discussed Overnight Care Regulations Title 22 102426 and provided a printout. The Licensee is requesting to increase to a Large Family Child Care with a capacity of 12-14 children. A fire clearance was granted on 11/01/22.

This is a one-story home which consists of 3 bedrooms, 1 bathroom, living room, dining room, kitchen, laundry area, office, front and backyards and detached garage, used for storage. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Areas used by children include: Living room (main childcare area), dining room, bathroom, office and back yard.

Areas off limits include: Bedrooms, kitchen, laundry area (located in kitchen), front yard, and detached garage. Off limit areas are made inaccessible by safety door knobs for the bedrooms, safety gates blocking entrance to the kitchen.

Knives and other sharp utensils are in the kitchen cabinet inaccessible to children in care. Cleaning products are located in locked cabinet under the sink in kitchen and in the laundry room. Smoke detectors and carbon monoxide detector were observed, tested and found to be operable. The homes has fans and portable oscillating heaters for safety and comfort. Per licensee, there are no poisons in the home. Applicant was advised that poisons need to be locked. ----------Page 1

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: OLIVER FAMILY CHILD CARE	FACILITY NUMBER: 198400406
	VISIT DATE: 11/09/2022

NARRATIVE

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The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. Isolation area for sick children waiting to be picked up is in living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

The bathroom that children use is located in the hallway and observed to be clean and free of hazards.

LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. Licensee states the following a sleep supervision plan for infants: Licensee or assistant stay in the same room as infant for the duration of the nap and document 15 minute checks.

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.

Currently, children are using the side and back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. There's no pool, spa or similar body of water on the premise. LPA has 3 small dogs observed to be in crates.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)

The facility file for Child #2 was not complete, which poses a potential risk for the health and safety of children in care.
Licensee has current Pediatric First Aid and CPR Exp: 06/9/23. Applicant has proof of immunization against pertussis and measles. Mandated Reporter Training expired on 06/23. Licensee provides food for children in care. Applicant was advised to properly label and store children's food if brought from home. -------------------Page 2 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: OLIVER FAMILY CHILD CARE	FACILITY NUMBER: 198400406
	VISIT DATE: 11/09/2022

NARRATIVE

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Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel
Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

Licensee 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.

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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Based on the LPA's observations and records review the following /no/ deficiencies will be cited today in accordance with California Title 22 Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Mia Oliver

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/09/2022 09:19 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 11/09/2022 at 03:21 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: OLIVER FAMILY CHILD CARE	FACILITY NUMBER: 198400406
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). 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 in 1 out of 2 children's files were not complete which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/16/2022
	Plan of Correction
1 2 3 4	Per licensee, the file for Child #2 will be completed and the documents will be sent to the department via email by POC due date

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. 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 in that the facility roster is incomplete, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/16/2022
	Plan of Correction
1 2 3 4	Per licensee, the facility roster will be completed and the documents will be sent to the department via email 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: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC809 (FAS) - (06/04)

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