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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801767
Report Date: 06/23/2022
Date Signed: 07/20/2022 01:04:47 PM

Document Has Been Signed on 07/20/2022 01:04 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WALTI FAMILY DAY CAREFACILITY NUMBER:
364801767
ADMINISTRATOR:WALTI, JACQUELINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 289-1329
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Licensee, Jacquelin WaltiTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Maddox met with licensee, Jacquelin Walti today for the purpose of conducting an unannounced 1 yr Required inspection. Present today was licensee only. The home is a single story family home with 3 bedrooms and 2 bathrooms. **There are no pools, spas or any other bodies of water on the premises. All adults in the home, (licensee, Brandy Johnson friend, Austin Walti, and Brandon Walti- son-no longer in the home) have fingerprint clearances and exams for T.B. The living room; den; dining area; side yard; enclosed patio room, and 1 bathroom are designated for child care.

Fireplace is screened and inaccessible; home has central heating and air conditioning; The kitchen and bathroom were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children. The outside play area was clear of chemicals and debris, the entire yard is fenced. All unused electrical outlets are plugged and play equipment and toys are available. Licensee has current CPR and First Aid training (exp 2/2024). Mandated reporter exp 2/2022. Per licensee, there are no weapons or firearms of any kind on the premises. Licensee has a current roster and documentation of Emergency Drills and proof of her current immunization's.

There is a fully charged fire extinguisher, and working carbon monoxide detector in the home.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WALTI FAMILY DAY CARE
FACILITY NUMBER: 364801767
VISIT DATE: 06/23/2022
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******Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 o 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 - No children require IMS at this time.

New Safe Sleep Regulations were discussed with licensee including checking in on Infants every 15 min and documenting the 15 min checks, LPA also discussed form LIC 9227 that's also part of the new safe sleep Regulations (102425 Infant Safe Sleep), Licensee states she is aware of the new Regulations and also has the log to document the 15 min checks.

The licensee is aware of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

Any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

As a result of this unannounced inspection, there are no violations noted, home was found to be incompliance with Title 22 Regulations. Exit interview conducted, copy of report left with Licensee.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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