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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314065
Report Date: 08/25/2022
Date Signed: 08/25/2022 10:56:53 AM

Document Has Been Signed on 08/25/2022 10:56 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:WICK, BRIANNEFACILITY NUMBER:
304314065
ADMINISTRATOR:WICK, BRIANNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 374-3984
CITY:IRVINESTATE: CAZIP CODE:
92606
CAPACITY: 14TOTAL ENROLLED CHILDREN: 1CENSUS: 2DATE:
08/25/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:LicenseeTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced in-person Pre-Licensing inspection for a new Large Family Child Care home. LPA met with Applicant, Brianne Wick who provided a tour of the new home. Applicant and LPA toured the facility inside and out. Present were also applicant's minor child and a 3 year old child form another family.

A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared.
Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes, to notify the licensing office.

Applicant is requesting for a Large Family Childcare Home License. The licensee is qualified for obtaining a Large Family Child Care License. Operation hours will be Monday to Friday 7:30 AM to 5:30 PM and care and supervision shall be provided to children ages 8 weeks old to 12 years of age. Fire clearance has been received in our office.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story town home with 2 bedrooms, 2 and half bathrooms, Family room, Dinning room area, kitchen, laundry room, and patio yard on the first floor.
Areas that will be used by children were inspected for safety, comfort, cleanliness, The bedrooms are upstairs and are off limit. There is a gate installed in front of the stairs. Kitchen has been barricaded by a baby gate from two entrances. The designated area for children are: family room, dinning room and children's bathroom. Telephone service (cell phone is the primary contact phone). Control of property was
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: WICK, BRIANNE
FACILITY NUMBER: 304314065
VISIT DATE: 08/25/2022
NARRATIVE
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reviewed and submitted to LPA during this inspection.



Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children stored in top cabinets. The Licensee states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock.

Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant has designated second level of the home, which has two bedrooms, and two bathrooms and kitchen as off limits area for children. Garage is also in the off limit area. .

There is a child safety gate installed at the beginning of the stairway making the second level inaccessible, kitchen is open, currently applicant has placed two baby gates in front of two entrances to kitchen area and making it inaccessible to children.

Garage door is separated from the home in the outside area and is off limit. The fire place in the day care family room is barricaded by a locked glass door. The patio is located on the first floor. The family room has a sliding door leads to the patio which is locked. The screen door has a lock too. There is a baby gate in the patio area which is locked too.

During the Pre-licensing inspection, LPA observed the designated off limits areas were inaccessible to children.

Licensee shall use the Cell phone for Day care activities and applicant was informed if a cell phone is used for child care, 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.
Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
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: WICK, BRIANNE
FACILITY NUMBER: 304314065
VISIT DATE: 08/25/2022
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Areas Designated for Day care activities: Parents and children shall enter the home, through the main door, opening into the hallway area of the home. The licensee stated parents will provide pack and play for children under 24 months old and mats including linens and blankets for children over 2 years of age. Applicant shall provide ongoing supervision during nap time.

The children's bathroom which is a half a bathroom is located in the passage area, in front of the entrance door. The children's bathroom was observed to be safe and free of hazardous items.

Applicant will provide AM/PM snacks and lunch to the children. If food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

Applicant was advised to follow the CDC and Local Health Department guidelines due to pandemic.

OUTDOOR PLAY AREA: Applicant stated she would use the patio located on the first floor for outdoor activities. It is fenced with concrete flooring. There is a gate that opens to the apartment complex environment which is locked. The applicant stated she might take the children out to the playground of this apartment complex.

There are no pets, firearms, weapons, bodies of water in the home.

The value on the 2A10 BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Applicant has mounted the Fire extinguisher on the side wall of the laundry room. Smoke detector/ Carbon Monoxide is mounted on the ceiling of the passage area on the first floor and second level.



Applicant has completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 12/3/2022.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
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: WICK, BRIANNE
FACILITY NUMBER: 304314065
VISIT DATE: 08/25/2022
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The following was discussed with the applicant during today's inspection:
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 Pediatric First Aid and CPR certification, TB clearance along with a valid criminal record clearance associated to the facility license.

Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated. The fire extinguisher type 2A-10 BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, No Johnny jumpers, No Baby walkers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

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



LPA discussed the following items with the Applicant Brianne Wick during the Exit interview:

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: WICK, BRIANNE
FACILITY NUMBER: 304314065
VISIT DATE: 08/25/2022
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Criminal Record statement: Applicant, Brianne Wick was reminded that all adults 18 and over living or working in the home, 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.


Safe Sleep : LPA discussed the safe sleep regulations with applicant, Brianne Wick & 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 the applicant, Brianne Wick 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. A sample of 15 minutes check on infants under 24 months old was provided to the applicant along with Individual Infant Sleeping Plane (LIC 9227)

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: 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.

Review of records to be maintained : LPA reviewed with Applicant , Brianne Wick the LIC 311D, Forms/Records To Keep In her Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. (LPA gave the LIC 311D with all the required forms and Fire logs to be maintained in the home)

Subscribe to CCLD important information

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 Continued on page 6

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: WICK, BRIANNE
FACILITY NUMBER: 304314065
VISIT DATE: 08/25/2022
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other important information communication platform. To receive important license- 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 improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.



OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 14 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements and additional forms were given to the applicant.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

The facility at the time of Pre-licensing inspection is in compliance for a (Large Family Chid Care Home)


The license is pending until final review at our office.

Exit interview was held and appeal rights were presented.

End of reports.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
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