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32 | Written statement from parent(s) or authorized representative exempting child from medical assessment, immunization, and treatment because of adherence to a religious faith that practices healing by prayer or other spiritual means; or physician's statement that immunization is not indicated.
Centrally Stored Medication and Destruction Record (LIC 622), if medications are handled.
Documentation of unusual behavior or signs of illness, special needs.
Unusual Incident/Injury Report (LIC 624).
Signed and dated receipt of Notification of Parents’ Rights (LIC 995).
Personal Rights — Community Care Facilities, Child Care Facilities (LIC 613A) receipts, signed and dated.
Authorizations for dispensing medication, signed by each child’s authorized representative.
Documentation required for health-related services, if needed (e.g., blood-glucose monitoring and nebulizer care).(LIC 9166). Gastrostomy Tube Care: Physician’s Checklist (LIC 701A). Acknowledgement of receipt of licensing reports (LIC 9224), if applicable.
Facility shall maintain Administrative Records which shall have the following:
Written inspection procedures for accepting children on a daily basis.
Sign-in/sign-out sheets kept for current 30 days, or approved waiver to use electronic pin system.
Admission policies, including admission criteria, ages of children who will be accepted; medical assessment requirements; program activities, supplemental services, if any; field trip provisions, transportation arrangements, food service, if any.
Designation of Facility Responsibility (LIC 308).
Personnel Report (LIC 500) showing current roster.
Licensee affidavit regarding persons exempt from fingerprint requirements (Use back of LIC 500).
Emergency Disaster Plan (LIC 610) (a posting requirement; see below) with verification that disaster drills are conducted every six months. Documentation of drills shall be maintained for at least one year.
Up-to-date list of qualified teacher substitutes.
Annual licensing reports and substantiated complaints from the last three years (must be available at the center for public review). And a Child Care Facility Roster (LIC 9040).
The applicant was advised to access the Licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes, and especially the Quarterly Updates.
As of 9/11/23, facility is granted with provisional license to serve 16 infants until the play yard structure is removed then regular license will be issued. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Gwendolyn Bias. Page 4/4 |