198400512-3-1-2022-54-CC-AMOY-CC4RNU-20220301121054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400512
Report Date: 03/01/2022
Date Signed: 03/01/2022 12:11:15 PM

Document Has Been Signed on 03/01/2022 12:11 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:	THOMPSON FAMILY CHILD CARE		FACILITY NUMBER:	198400512
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/01/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Courtney Thompson, Applicant		TIME COMPLETED:	12:15 PM

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On February 03, 2022 Licensing Program Analyst (LPA) Alicia Mooberry conducted a pre-licensing inspection for the above address. LPA met with Courtney Thompson, Applicant, guided LPA on a tour of the facility. Individuals residing in the home were discussed and noted. Per Applicant, hours of operation will be Monday through Sunday, 6:00 am to 6:00 am not to exceed 24 hour care at one time. Applicant states that she will care for children Infants -12 years of age. An plan for overnight care will be created for children that are staying overnight.
This is a one-story home which consists of 3 bedrooms, 1 bathroom, den, kitchen, laundry room, front and backyard (fenced) and detached garage located in the back of the home. 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: Bedroom 1 and 2, living Room (main daycare area), kitchen, bathroom, front and back yard

Areas off limits include: Bedroom #3, laundry room, den, and detached garage

The off limit areas are all in the rear of the home, are maintained inaccessible by a safety gate in the kitchen leading to the den. Knives and other sharp utensils are located in overhead cabinet in the kitchen. Cleaning products were located in cabinets locked with safety latches under the sink in kitchen and bathroom and in the overhead shelves in the laundry room.

The home is clean and orderly, there are outlet covers throughout the home. Smoke detectors and carbon monoxide detector were observed, tested and found to be operable.

Applicant has completed the required health and safety training, the Pediatric First Aid and CPR Exp. 12/23 . Applicant has proof of immunization against pertussis and measles, influenza. Proof of Mandated Reporter Training . ---Page 1

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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: THOMPSON FAMILY CHILD CARE	FACILITY NUMBER: 198400512
	VISIT DATE: 03/01/2022

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The required postings were observed. Applicant states she will provide food for children in care. Applicant was advised to properly label and store children's food if brought from home.
LPA observed age appropriate toys and learning materials. The required (2A10BC) fire extinguisher was observed in the living room by the kitchen. First Aid kit is available.
Per Applicant, there are no weapons or firearms in the facility, none were observed by LPA. Applicant has no pets at this time.
The wall heater was observed to be covered and secured to the wall. The applicant will use fans to maintain home comfortable.

Per applicant, the front and back yard will be used as outdoor play area. The yards are enclosed with shade and grassy play area. The detached garage in the back yard was observed to be locked and is utilized storage. Safe and age appropriate toys were available. There are no bodies of water on the premises. Applicant will used the off limit den as a walk way to the backyard - a written plan of supervision was provided by applicant on this date.

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA provided the Safe Sleep regulation and provided PIN 20-24-CCP and the Infant Sleep Plan LIC 9227 for when Applicant is ready to enroll infants. Children will nap in bedroom #1, mats and a crib are available.

LPA discussed the safe sleep regulations with applicant 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.

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: http://www.ada.gov/childqanda.htm
---Page 2

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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

FACILITY NAME: THOMPSON FAMILY CHILD CARE	FACILITY NUMBER: 198400512
	VISIT DATE: 03/01/2022

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LPA Provided COVID-19 Technical Assistance by emailing applicant COVID-19 resources and self-assessment prior to visit. LPA discussed self-assessment and answered question regarding COVID-19 procedures. LPA advised applicant to ensure they are following the guidance from the local health authorities in order to prevent and reduce the transmission of diseases.
Per applicant parents will drop off/pick up at the front door. Daily temperature checks and health screenings are done at the entrance. COVID-19 posters and resources have been posted in the entrance accessible to parents. Parents will be made aware of the COVID-19 policies and exclusion procedures in writing and verbal. Per applicant, high touched areas, bathroom and toys will be disinfected at the end of the day or as needed. There is a dirty/soiled toy bin to be cleaned when applicable and high touched toys will be cleaned daily.
Per applicant children will be encouraged to was their hands for 20 seconds throughout the day as needed. Applicant has the advised children's hand washing and cough and germs posted. Per applicant personal items will be placed in an individual cubby. Children will bring their own blanket and sheet for nap. Bedding will be washed weekly or as needed.
The isolation area for a sick child waiting to be picked up will be in the living room next to the exit away from other children.

The following was discussed with the applicant:

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization, Mandated Reporter training certificate www.mandatedreporterca.gov, and a valid criminal record clearance associated to the facility license.

-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

-Unusual incident or any changes will be reported to Licensing within 24 hours and an LIC 624B will be submitted within 7 days.
---Page 3

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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

FACILITY NAME: THOMPSON FAMILY CHILD CARE	FACILITY NUMBER: 198400512
	VISIT DATE: 03/01/2022

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LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

A small family childcare license will be granted upon Licensing Program Manager (LPM) Approval. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.
Exit interview conducted and report was reviewed with Courtney Thompson, applicant

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4