336300586-8-9-2022-10-CC-AFLS-CH5T78-20220809142819

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336300586
Report Date: 08/09/2022
Date Signed: 08/09/2022 04:00:30 PM

Document Has Been Signed on 08/09/2022 04:00 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	MCKENZIE FAMILY CHILD CARE		FACILITY NUMBER:	336300586
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	08/09/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:56 PM
MET WITH:	Kimberly Mckenzie		TIME COMPLETED:	02:39 PM

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	On August 9, 2022 at 12:56 PM, Licensing Program Analysts (LPAs) Anastasia Flores an Andrea Taylor arrived at the facility to conduct a pre-licensing inspection. Present during this inspection were Kimberly Mckenzie and her three adult children. The home is two stories with 6 bedrooms, 3 bathrooms, with attached garage. LPAs toured the facility, inside and out with Applicant and the following was observed and/or discussed: · Per Applicant, off-limit areas include: Garage , complete second floor, right side yard, kitchen and formal living room. Off-limit areas have key locks and or have child gates making them inaccessible to children. During today's inspection. Any hazardous material observed by LPA's during inspection were removed and made inaccessible. · Normal hours of operation will be: Sunday through Saturday from 5:00 AM to 12:00AM · Smoke detectors and Carbon Monoxide detectors were observed to be present at the facility but were not tested by the applicant during this inspection. · There is central heating and air conditioning. · The fire distinguisher is a 2A:10 :B:C , fully charged and met standards established by the State Fire Marshal. · All hazardous items were observed to be inaccessible. Storage of poisons and toxins are inaccessible to children and locked in the garage behind a dead bolt. Sharp items including kitchen knives, are inaccessible and stored in cupboards out of reach. Medicines are locked and stored in an off limit are and made inaccessible. · First Aid Kit is located on top shelf in the day care room and contains all required items. · No guns or weapons are stored in the facility as of this date as stated by Ms. McKenzie. Applicant understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MCKENZIE FAMILY CHILD CARE	FACILITY NUMBER: 336300586
	VISIT DATE: 08/09/2022

NARRATIVE

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· Stairs are barricaded
· There is no fireplace at the facility
· Clean, safe and age appropriate toys were observed.
· LPAs observed a working telephone (licensee's cellphone).
· There were no toxic plants inside or outside the facility observed at this time
· The outside activity area consists of: toddler size play equipment, child size basketball hoop, bean bags and child size plastic chairs.
· There are no bodies of water observed on this date. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and 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 bodies of water described. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Verification of control of property is maintained by applicant
· Emergency Disaster Plan is posted. Applicant was advised to post the facility sketch with off limit areas marked
· Pediatric CPR and First Aid Card is not approved by EMSA or EMR, applicant was advised that it needed to be EMSR certified.
· Mandated Reporter certificate expires 09/20/2021
· Preventive Health and Safety training, including nutrition and lead components have been completed 03/16/2016
· The applicant, Kimberly Mckenzie, confirmed there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.
- Responsibilities of being a mandated reporter and updating training every 2 years
- Personal rights of children in care, including no corporal punishment
- Responsibility to know the Title 22 Regulations for anyone providing care and supervision
- Capacity and Supervision requirements
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility phone numbers must always be on file with the licensing office
- Baby walkers, bouncy seats, exert-saucers and other similar items are prohibited
- Car seat law
- Smoking is prohibited in the facility while providing child care or transporting children

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MCKENZIE FAMILY CHILD CARE	FACILITY NUMBER: 336300586
	VISIT DATE: 08/09/2022

NARRATIVE

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Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of
30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also
be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
-The Applicant can submit fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov
- Access to forms & Title 22 Regulations for Family Child Care Homes online at www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

LPA discussed the safe sleep regulations with licensee, 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 also informed licensee, 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.

LPA reviewed with licensee, the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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 other important information communication platform.

The application for a Small Family Child Care Home will be submitted for approval with a maximum capacity of 6, or 8 with parent notification upon completion of the following items;
1. CPR/First Aide to be completed by EMSR certified provider
Applicant understands that she will need to complete the above item prior to being licensed and will have thirty days to complete or the agency will deny the application.
Exit interview conducted and report was reviewed with the applicant (Kimberly Mckenzie).

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

LIC809 (FAS) - (06/04)

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