304313804-8-11-2021-06-CC-STOE-C5SP4K-20210811105915

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313804
Report Date: 08/11/2021
Date Signed: 08/11/2021 10:59:20 AM

Document Has Been Signed on 08/11/2021 10:59 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	SULLIVAN, MARILYN		FACILITY NUMBER:	304313804
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	08/11/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Marilyn Sullivan, Licensee		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Stacy Torrence conducted a case management inspection, in response to licensee’s request for a capacity increase. LPA met with licensee Marilyn Sullivan who guided analyst on a tour of the facility. There were five preschool children present at the time of inspection. LPA Torrence observed five children playing in the backyard. Licensee does not care for infants. The facility was within licensed capacity and the required ratio. Licensee stated there are currently three adults and one minor child living in the home. Licensees stated she is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes to notify the licensing office. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility is a three-story home which consist of three bedrooms, two bathrooms, located on the third floor, second floor is the entrance of the home, where the living room, kitchen, and dining room is located. The first floor is where the family room, half bathroom, and backyard (fenced), which is the designated daycare area. Off limits areas: entire second and third floors, garage, front yard, and locked shed located in the backyard. Licensee has placed a safety gate at the bottom of the stairs leading to the second and third floors. There is a bar located in the family room, which is made inaccessible by a child safety gate. The licensee acknowledged the children may never enter the off-limit areas. Control of property was verified and a copy of obtained. The home was clean, orderly, and was at a comfortable temperature. There is a fireplace located in the family room; which is barricaded by a screen gate. Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen, is part of the off-limited area. Poisons/Hazardous items are not stored on site, and none were observed. Continue on next page (1 of 4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SULLIVAN, MARILYN	FACILITY NUMBER: 304313804
	VISIT DATE: 08/11/2021

NARRATIVE

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There are no bodies of water on the premises. The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. Licensee stated there are no weapons or firearms on the premises. When firearms are present, they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged. Outdoor activity is conducted in the back yard. This is also a chicken coop in the back yard, which is gated. Licensee’s children records were reviewed and were in compliance with Title 22. Roster and fire drill was current.

EMSA approved Pediatric CPR and Pediatric First Aide are current for the licensee and expires on 08/2022.

LPA advised the licensees how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

During todays’ inspection, there were no deficiency cited and licensee was in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.

A new license for operating a Large Family Child Care Home shall be issued upon final review and if additional information is needed, licensee shall be contacted.

An exit interview was conducted. The report was reviewed and discussed with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. The Notice of Site Visit must be posted on or adjacent to the door. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.

End of Report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC809 (FAS) - (06/04)

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