376101231-6-26-2023-51-CC-NDIZ-CT6LYE-20230626091013

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376101231
Report Date: 06/26/2023
Date Signed: 06/26/2023 09:10:21 AM

Document Has Been Signed on 06/26/2023 09:10 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	WHITE, AMBER FAMILY CHILD CARE		FACILITY NUMBER:	376101231
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	06/26/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Amber White		TIME COMPLETED:	09:20 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	On 6/26/23 at 8:00AM, Licensing Program Analyst(LPA) Nancy Diaz conducted an announced Pre-Licensing inspection with the applicant, Amber White. Observed present today were 3 children (2 children were siblings and applicant's son). This 3-bedroom, 2-bathroom single family home was toured and inspected to ensure an environment safe for the care and supervision of children. The applicant provided proof of control of property. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Applicant maintains smoke and carbon monoxide detectors in the home that meets regulation requirements. The combination detector was tested today and deemed to be operable. All hazardous items were latched and secured under the kitchen sink and are out of reach of children. Mrs. White stated that she does not maintain any weapons. Applicant maintains a first aid kit in the home. 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 clearances or exemptions. Control of property was provided to the department via copy of lease agreement. First Aid and CPR will expire on 4/2/2024 and Preventative Health Practices course was completed on 4/10/2022. Mandated Reporter Training was completed on 8/25/2022. The daycare children will have access to: living room, family room, dining, kitchen, hallway bathroom and back fenced yard. Off limits are: all 3 bedrooms, garage and bathroom in the first hallway.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WHITE, AMBER FAMILY CHILD CARE	FACILITY NUMBER: 376101231
	VISIT DATE: 06/26/2023

NARRATIVE

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LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

The new provider packet was also reviewed with the applicant including information on child abuse reporting, children’s records, immunizations, adults living or working in the home, SIDS, Incidental Medical Services, and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed Shaken Baby Syndrome and California Megan's Law and LPA provided: www.meganslaw.ca.gov.

Applicant has met all immunization requirements per SB792 and have completed the AB1207 Mandated Reported Training. Applicant is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Applicant states that she will comply with all regulations and laws governing family child care homes and that she is financially secure to operate a family child care home for children. LPA reviewed this report with Applicant prior to obtaining her signature.

LPA discussed and provided applicant with the following: Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov and phone number (916) 654-1541.In addition, for common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WHITE, AMBER FAMILY CHILD CARE	FACILITY NUMBER: 376101231
	VISIT DATE: 06/26/2023

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LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Incidental Medical Services (IMS) policy was discussed. Mrs. White stated that she does not plan to maintain medications for day care children. 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) or (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.

Mrs. White was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.
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.

CORRECTION NEEDED PRIOR TO LICENSURE:
- Obtain a regulation size Fire extinguisher (2A10BC)
An exit interview was conducted with the applicant. A copy of this report and appeal rights were provided.
A notice of site visit was given to [applicant, licensee or facility representative] and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC809 (FAS) - (06/04)

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