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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846207
Report Date: 10/07/2024
Date Signed: 10/07/2024 04:40:32 PM

Document Has Been Signed on 10/07/2024 04:40 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:AHLSTRAND FAMILY CHILD CAREFACILITY NUMBER:
334846207
ADMINISTRATOR/
DIRECTOR:		AHLSTRAND, DEVIN LEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 651-1295
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
10/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:11 PM
MET WITH:Devin Le AhlstrandTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On 2024 at 2:11 PM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection. LPA was greeted by Licensee Devin Le Ahlstrand and granted entry to tour the facility inside and out. LPA reviewed records and observed and/or discussed the following: Present were the licensee, 2 adult residents and 1 minor resident. The licensee was temporarily away from the facility to pick up School Age Children and returned at 2:45 PM, with a total of 3 children. In Jan 2024, the licensee notified the department of changes to the LIC999A Home Facility Sketch and composition of the home changes. The daycare areas are the front living room, dining room and ½ bath across from the staircase.

Normal days and hours of operation: Monday to Friday, 7am to 5pm.
OFF-LIMIT AREAS INCLUDE: 1st Floor craft room/restroom; Garage, Entire 2nd Floor, Laundry room and Backyard.

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights. The inspection found the facility to be in compliance in these domains.
· The facility is operating within the licensed capacity and appropriate ratios. The licensee is currently operating at a small capacity due to low enrollment.
· The Licensee is present in the home and has ensured that children in care are supervised. LPA took a census of 4 children in care.
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.
· A working telephone is present.
· A fully charged fire extinguisher (2A:10BC) was observed to have the needle in the green. A smoke detector and carbon monoxide detector were present and tested by the licensee during this inspection.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: AHLSTRAND FAMILY CHILD CARE
FACILITY NUMBER: 334846207
VISIT DATE: 10/07/2024
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· All hazardous items are inaccessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children.
· Storage of poisons are inaccessible to children and are locked in the garage on 10/07/2024.
· Stairs are barricaded on 10/07/2024.
· The fireplace is properly screened on 10/07/2024.
· No guns or weapons present as stated by the Licensee. Licensee Devin Le Ahlstrand understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas on the premises is Off Limits to daycare. The licensee takes children to a nearby park for outdoor activities.
· Verification of control of property on file by grant deed.
· Pediatric CPR and First Aid training on 05/23/2023; Card expires on 05/23/2025.
· Health & Safety Certificate - completed on 01/28/2017.
· Mandated reporter General: 03/2023; AB 1207 Child Care Expires: 03/2025
· Fire clearance on file.
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 05/01/2024 at 12:00 PM with 3 children in care and lasted 30 minutes.
· There are no bodies of water 10/07/2024. Licensee Devin Le Ahlstrand, understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Children’s files are NOT complete: 2 infants under 24 months in care missing sleep logs.
· Staff’s files are complete. No employee files at this time. The licensee is operating at a small capacity due to low enrollment and is in the process getting a qualified assistant.
· A review of staff records on 10/07/2024 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: AHLSTRAND FAMILY CHILD CARE
FACILITY NUMBER: 334846207
VISIT DATE: 10/07/2024
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To receive important licensed-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 receive email communication.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. 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

Licensee Devin Le Ahlstrand, 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.

LPA Susan Brewer, discussed the safe sleep regulations with licensee Devin Le Ahlstrand 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.

LPA Susan Brewer, also informed licensee Devin Le Ahlstrand, 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.

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.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: AHLSTRAND FAMILY CHILD CARE
FACILITY NUMBER: 334846207
VISIT DATE: 10/07/2024
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 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.

A deficiency was issued on today’s date for a Type B violation.

No civil penalties issued on 10/07/2024

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Devin Le Ahlstrand.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/07/2024 04:40 PM - It Cannot Be Edited


Created By: Susan Brewer On 10/07/2024 at 04:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: AHLSTRAND FAMILY CHILD CARE
FACILITY NUMBER: 334846207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 2 infants present and in care did not have current sleep logs, where the last entry was 04/17/2024 on the sleep log for an infant 22 months of age which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2024
Plan of Correction
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The licensee agrees to ensure documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check and/or other notes required during sleep checks. In addition, the licensee agrees to submit a written statement of understanding the safe sleep regulations, proof of the sleep logs for enrolled infants and the plan for implementing the safe sleep regulations for children under 2 years of age.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2024


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