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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313268
Report Date: 10/05/2023
Date Signed: 10/05/2023 04:28:50 PM

Document Has Been Signed on 10/05/2023 04:28 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ROY, GERALDINEFACILITY NUMBER:
304313268
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
10/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Roy, Geraldine TIME COMPLETED:
04:45 PM
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10/05/2023 at 2:45PM Licensing Program Analyst Karen Navar conducted an unannounced case management inspection. LPA met with licensee Geraldine Roy and conducted a tour of the facility. Census was taken 4 children and 1 infant were present. 6 adults live in the facility and have been finger printed and background check.

The facility is a two-story home with five bedrooms, three bathrooms, 2 fireplaces.

The licensee has designated the family room that has a fireplace and is barricaded by a screen with a child safety gate, one sliding glass door that leads to the backyard play area, kitchen, and downstairs bedroom as daycare use. The daycare bathroom is in the hallway next to the downstairs bedroom.

The off-limits areas are designated as the living room, garage, and entire upstairs. The living room is made in accessible to children with a child safety gate. One gate is in the kitchen and one gate is in the hallway.
A door in the hallway next to the family room leads to the garage. Licensee has made the garage inaccessible to children with a child safety gate.

The backyard has age-appropriate toys and two fences that are latched that lead to front of the house. The off limits fenced patio is made in accessible to children with a child safety gate. Gate leading to park has sliding latch. Licensee uses park as an area to play during business hours.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ROY, GERALDINE
FACILITY NUMBER: 304313268
VISIT DATE: 10/05/2023
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The licensee has a cell phone to use for childcare. LPA informed the licensee that the cell phone must always remain on the premises during hours of operation M-F 7:00am-4:00pm. The licensee stated that she provides breakfast, lunch, and snack. The license stated if children have allergies depending on allergy, she will substitute the food or parents will have to bring the food depending on the allergy. The licensee stated that the home is free from smoking during hours of operation. Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen are all inaccessible to children.. Poisons/Hazardous items are not stored on site, and none were observed.

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by law to post the following:

Facility License (LIC 203), Waivers (if applicable), Notification of Parent’s Rights Poster (PUB 394), Earthquake Preparedness Checklist (LIC 9148), Emergency Disaster Plan (LIC 610A) California Car Seat Law (PUB 269). ). A Notice of Site Visit (LIC 9213) must be posted 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

LPA reviewed Unusual Incident Report (UIR) form (LIC 624B)-advised to contact Licensing Officer of the Day within 24 hours and complete the UIR within seven days by faxing LIC624B to (714)703-2831. LPA advised applicant to report to licensing any unusual incident or child absence that threatens the physical or emotional health or safety of any child or any changes to hours and days of operation and for any changes to facility, including on/off limit areas and change in phone number.

LPA reviewed with licensee requirements of Disaster Preparedness drills (documented every 6 months). The LPA advised of Affidavit Regarding Liability Insurance (LIC 282) if did not purchase liability insurance and to maintain the form in the children's files, and Car Safety Seat pamphlet were discussed and provided to the applicant.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ROY, GERALDINE
FACILITY NUMBER: 304313268
VISIT DATE: 10/05/2023
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The licensee has completed the Mandated Reporter Training for self and 03/2024. Department web site form was given to download forms, Title 22 regulations, and trainings on-line at http://www.ccld.ca.gov. The licensee has registered to obtain quarterly updates and notifications from the Department. Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. was provided. LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment. A copy of “A Child Care Providers Guild to Safe Sleep” was provided to applicant: English:

LPA discussed the safe sleep regulations with the 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. LPAs also informed the 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.



The applicant was given a pamphlet on Lead Exposure and was discussed with the provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chapter Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdfAppeal Rights and the appeal rights process was discussed with the applicant. The applicant was informed all appeals must be in writing and received by the licensing office within 15 business days.

An exit interview conducted where the report was reviewed with the Geraldine Roy. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

The Small Family Child Care Home was in compliance with Title 22 Regulations at the time of inspection. In the event additional requirements are needed, the applicant will be notified. Continue Pg 4

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ROY, GERALDINE
FACILITY NUMBER: 304313268
VISIT DATE: 10/05/2023
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Appeal rights were provided, and an Exit Interview was conducted with applicant Geraldine Roy.

The operation hours are from 7:00am to 4:00pm Monday through Friday for ages 3 months – 5 years.

This report ends here.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Karen Navar
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC809 (FAS) - (06/04)
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