376101334-1-5-2023-51-CC-NDIZ-CMSNDF-20230105092217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376101334
Report Date: 01/05/2023
Date Signed: 01/05/2023 09:22:28 AM

Document Has Been Signed on 01/05/2023 09:22 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:	NISHI, YASUYO FAMILY CHILD CARE		FACILITY NUMBER:	376101334
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/05/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:			TIME COMPLETED:	09:45 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 1/5/2023 at 8:15AM, Licensing Program Analyst(LPA) Nancy Diaz conducted an announced Pre-Licensing inspection with the applicant, Yasuyo Nishi. Her husband George Petropulos was also present today. This 3-bedroom, 3-bathroom two-story family home was toured and inspected to ensure an environment safe for the care and supervision of children. Applicant maintains smoke and carbon monoxide detectors and fire extinguisher in the home that meets regulation requirements. Both detectors were tested today and deemed to be operable. All hazardous items were latched and secured in the laundry room and are out of reach of children. Mrs.Nishi 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 San Diego County Tax statement. First Aid and CPR will expire on Sept. 2024 and Preventative Health Practices course was completed on September 18, 2022 (This includes Lead Poisoning Prevention). Mandated Reporter Training was completed on September 13, 2022. Mrs. Nishi was reminded that the Mandated Reporter Training and Pediatric CPR/First aid are only valid for 2 years. The daycare children will have access to: living room, dining, downstair bathroom and back fenced yard. Off limit areas are: garage, laundry room, kitchen, family room and all of the second floor. A barricade was installed to make the second floor of the home inaccessible to children.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: NISHI, YASUYO FAMILY CHILD CARE	FACILITY NUMBER: 376101334
	VISIT DATE: 01/05/2023

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
26
27
28
29
30
31
32

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 and LPA discussed COVID-19 guidelines and how to prevent spread of the virus. Applicant has posted COVID-19 posters in facility. Applicant was provided COVID-19 resources and directed to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

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.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: NISHI, YASUYO FAMILY CHILD CARE	FACILITY NUMBER: 376101334
	VISIT DATE: 01/05/2023

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
26
27
28
29
30
31
32

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.

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 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

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.

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.
CORRECTIONS NEEDED PRIOR TO LICENSURE:
- Submit a facility sketch of the second floor.
- Install barricade appropriately (between the kitchen and hallway)
- Remove the plants with thorns (in the backyard)
An exit interview was conducted with the applicant. A copy of this report and appeal rights were provided.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3