376629128-7-13-2021-20-CC-RGOU-C4VR28-20210713123754

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629128
Report Date: 07/13/2021
Date Signed: 07/13/2021 12:38:07 PM

Document Has Been Signed on 07/13/2021 12:38 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	MOORE, CHERYL FAMILY CHILD CARE		FACILITY NUMBER:	376629128
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/13/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Cheryl Moore		TIME COMPLETED:	11:00 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 07/13/21 at 8:34 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an announced Pre-Licensing inspection. Upon visit, LPA met with applicant, Cheryl Moore and proceeded to tour this one story, five-bedroom and three-bathroom home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. During the visit applicants spouse was present in the home. Facility plans to operate from Monday through Friday from 6:00 a.m. to 6:00 p.m. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational. LPA observed the required postings posted. There is a fire place located in the living room that is screened. Children’s toys and play equipment are safe and age appropriate. There is a pool located in the backyard that is partially fenced with a 5 feet high fence with openings no wider than four inches, and in no way obstruct a complete and clear view of the pool from the outside. However, there are two windows on the home leading to the inside of the gated pool area. One of the windows is located in the restroom the children will utilize and other window is located in bedroom #3 that is off limits. LPA informed applicant the fencing shall surround the pool to ensure there is no access to the inside of the pool area from the windows. In addition, the pool fence has two gates that are self-closing, self-latching and swing away from the pool, per LPA observation. There is one pool entrance that is located on the north side of the home and another entrance located near the front of the backyard. The applicant will utilize the backyard for outdoor activities. LPA informed applicant to ensure children are supervised at all times during outdoor activities. There are no firearms or other weapons in the home, per applicant. Primary telephone is a cell phone which is operational. Pediatric CPR and First-Aid certificate are valid through April 2023. There are no new adults living or working in the home. A review of clearances 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. Applicant has provided proof of control of property. Applicant has not met the immunization requirement. Verification of the Measles vaccination is not on file. Applicant has completed the AB1207 Mandated Reporter Training. LPA informed applicant the AB1207-Mandated Reporter training shall be completed once every two years the . Applicant has completed the 8 hour Preventative Health with Lead Prevention training in July 2021. See LIC809 continuation page…

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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: MOORE, CHERYL FAMILY CHILD CARE	FACILITY NUMBER: 376629128
	VISIT DATE: 07/13/2021

NARRATIVE

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Applicant will utilize the following areas for childcare: Living room, Dining room, Kitchen, Bedrooms #1 & #2, Two Bathrooms located in hallway of home, Family room (Daycare), and Backyard. Off limit areas of the home include: Master bedroom, Master bathroom, Bedrooms #3 & #4, and Garage. Off limit areas of the home are made securely inaccessible, per observation.

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 provided 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 following with applicant: reporting suspected child abuse & neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in home have criminal background clearances to avoid civil penalties, emergency drills conducted every 6 months and document drills including date/time and type of drill, heat-related illness, child passenger law, unusual incidents and time frames, information on SIDS, shaken baby syndrome, lead poisoning effects brochure. LPA informed licensee corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day care operation.

LPA informed applicant of Community Care Licensing Duty Line: (619) 767-2248, Monday through Friday from 8:00 a.m. to 5:00 p.m. Assigned LPA, Rajani Goudreau may be reached at (619) 767-2215 and at Rajani.Goudreau@dss.ca.gov.

LPA informed applicant there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. Sleeping infants shall be physically checked every 15 minutes and checks documented to reflect the following: date, time, and child's name. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall maintained for each infant up to 12 months of age. The provider shall place infants up to 12 months of age on their backs for sleeping. Safe sleep packet discussed and provided to the licensee. See LIC809-C continuation page...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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: MOORE, CHERYL FAMILY CHILD CARE	FACILITY NUMBER: 376629128
	VISIT DATE: 07/13/2021

NARRATIVE

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LPA discussed the following with applicant: maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the applicant's home.

The following is pending with a due date of July 30, 2021:

Place pool fencing near the back of the home where the two windows are located to prevent access from the windows to the pool area
Provide verification of the Measles Vaccination

An exit interview was conducted with the applicant. The following was discussed and provided to the applicant: LIC809 pages and appeal rights. After corrections are received and after final file review, a small family childcare license will be issued and mailed to the applicant. LPA informed applicant, once the license is received to post in a prominent place in the home.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC809 (FAS) - (06/04)

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