304313964-3-27-2023-06-CC-STOE-CQBPNT-20230327112829

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313964
Report Date: 03/27/2023
Date Signed: 03/27/2023 11:28:43 AM

Document Has Been Signed on 03/27/2023 11:28 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:	CLEMENS, SANDRA & ONYEBUJOR, NGOZI		FACILITY NUMBER:	304313964
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 7	CENSUS: 5	DATE:	03/27/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Sandra Clemens, Licensee		TIME COMPLETED:	11:30 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 Sandra Clemens, who guided analyst on a tour of the facility. During today’s inspection, licensee’s assistant Nkiruka Onyebujor was also present. LPA Torrence observed five children in the designated daycare area. The facility was within licensed capacity and the required ratio. Licensee stated there is currently five adults and two minor children living in the home. Licensee 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. This is a two-story home with six bedrooms, three bathrooms, living room, kitchen, dining room, laundry room, front yard (not fences), backyard (fenced), and garage. Licensee has designated the living room, one bathroom (first floor), one bedroom (1^st floor), and backyard as part of the day-care. Licensee has designated the entire 2^nd floor, kitchen, dining room, laundry room, front yard, and garage, as the off-limit areas. Licensee has placed safety locks and latches on the drawers and cabinets, making them inaccessible. Licensee has placed child proof safety gates at both entrances of the kitchen, at the entrance of the laundry area, and at the entrance of the bedroom (napping room) and dining room, ensuring these areas are inaccessible to the children in care. There are stairs in the home, barricaded by a child proof safety gate, at the bottom of them. Licensee acknowledged the children may never enter the off-limit areas, during operation hours. Control of property was verified by LPA during today’s inspection. The licensee has a cell phone that is used for childcare. Licensee was informed if a cell phone is used for childcare, it must remain on the premises at all times during hours of operation. Licensee was informed and understands the home is to be free from smoking during hours of operation.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CLEMENS, SANDRA & ONYEBUJOR, NGOZI	FACILITY NUMBER: 304313964
	VISIT DATE: 03/27/2023

NARRATIVE

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The facility does have a fireplace, located in the living room, barricaded by a sturdy bookcase. Cleaning solutions/chemicals, utensils, and sharp knives located in the kitchen, which is the off-limit area. Poisons/Hazardous items are not stored on site, and none were observed. There are no bodies of water. 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.

Licensee will use the backyard for children's outdoor activities. The back yard is appropriately fenced. LPA observed play equipment to be safe and free of hazards.

Per licensee, she provides breakfast, lunch, and snacks for the children. LPA reminded applicant, that if food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated. Per licensee, parents provide diapers, wipes, and lotion for the infants. Licensee stated she use a changing table to change the infants. LPA reminded licensee to always visual supervise the infant, while changing their diapers.

Per licensee, children nap in the napping room on mats or in a crib. Licensee stated she provide linen and blanket for the children.

Licensee was in compliance with the Safe Sleep 15-minute log. LPA advised licensee that all infants are required to be check every 15-minutes while sleeping, even if the infant is now sleeping on a mat or cot.

Licensee’s and Assistant’s Mandated Reporter Training were current. EMSA approved Pediatric CPR and Pediatric First Aid were current for licensee and assistant, which both expires on 11/23 and 06/24 respectively.

LPA advised the licensee 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, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CLEMENS, SANDRA & ONYEBUJOR, NGOZI	FACILITY NUMBER: 304313964
	VISIT DATE: 03/27/2023

NARRATIVE

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Fire clearance granted on 03/06/2023.

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.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC809 (FAS) - (06/04)

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