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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629557
Report Date: 02/06/2023
Date Signed: 02/06/2023 12:07:29 PM

Document Has Been Signed on 02/06/2023 12:07 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:ADEN, LUCKY FAMILY CHILD CAREFACILITY NUMBER:
376629557
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Lucky AdenTIME COMPLETED:
09:15 AM
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On February 6th, 2023, at 7:56 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a pre-licensing inspection with Applicant Lucky Aden. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present in the home was only the Applicant. This three (3) bedroom, two (2) bathroom house was toured and inspected. The daycare operational schedule will be weekends 12 AM to 11:59 PM.

The Applicant shall submit an updated application to the Licensing Department should the daycare operational schedule change. The Applicant understands that they will need to notify the Department of any changes to the childcare areas and obtain departmental approval before use of any new childcare areas not previously licensed. Applicant will use the following areas for childcare: the living room, dining room, one (1) bedroom, one (1) bathroom and the fenced backyard. The off limits areas include the kitchen, remaining bedrooms, and bathroom. Access into the kitchen is made inaccessible via a child safety gate. Doors to the remaining bedrooms and bathroom have door locks and a safety doorknob cover. There are no bodies of water observed during time of visit. The fire extinguisher is rated 2A 10B: C. and is located in the kitchen. The smoke and carbon monoxide detectors meet requirements and are operational. Poisons, detergents, cleaning compounds and medications are secured inaccessible to children in care by placement in an off limit bedroom, off limit bathroom and in the off limit kitchen. Children’s toys and play equipment are available. The Applicant has a working telephone/cell phone. The Applicant shall notify licensing should their telephone number or email address ever change. The Applicant indicated there are no firearms or other weapons in the home.

The Applicant intends to conduct outdoor activities in the fenced backyard. The Applicant acknowledges continuous, visual supervision shall be given whenever children are engaged in outdoor activities. The Applicant intends to occasionally transport the children in their own vehicle. The Applicant shall transport children in rear seats in appropriate child passenger restraint systems which meet applicable federal motor
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
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: ADEN, LUCKY FAMILY CHILD CARE
FACILITY NUMBER: 376629557
VISIT DATE: 02/06/2023
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vehicle safety standards. The Applicant acknowledges that car seats shall only be used for transportation purposes and shall not be used for sleeping. The Applicant acknowledges children shall never be left unattended in the daycare vehicle. The Applicant further confirms maintenance of the daycare vehicle shall be upheld to ensure safety.

Applicant maintains documentation of proof of control of property for review by the Department. Applicant has completed the preventative health and lead poisoning prevention courses. The Mandated Reporter training was completed on 01/15/2023. Pediatric CPR and First Aid certifications expire in June 2024. The Applicant and adult residents in the home have criminal record clearances and/or exemptions on file. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and adults 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.

The Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and comply.



LPA discussed the safe sleep regulations with the 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. 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)/ (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

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
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: ADEN, LUCKY FAMILY CHILD CARE
FACILITY NUMBER: 376629557
VISIT DATE: 02/06/2023
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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. Entrance Checklist was provided to the applicant. LPA and Applicant discussed the facility disaster plan and safety of children and pets. Applicant has no pets.

The Applicant was also informed the following items are prohibited during day care operating hours: walkers, exersaucers, jumpers, inclined sleepers, and bouncy seats. Corporal punishment and smoking are not allowed in the day care.


Applicant and LPA reviewed the ratio/capacity worksheet for a small family home license. LPA discussed the maximum capacity for a small family childcare home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home. Landlord consent is on file.

The Applicant agrees to comply with all regulations and laws governing family childcare homes.

Applicant was advised that any agent of the Licensing Department upon presentation of proper identification, may enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice. The Applicant shall permit the Department to inspect the family childcare home, and to privately interview children or adultsf, to determine compliance with or to prevent violations of family childcare laws or regulations. Applicant was advised that the Department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, if the Applicant refuses any agent of the licensing Department entry into the daycare or any part of the daycare.

LPA informed Applicant that the failure of a Licensee to pay all applicable and accrued fees and/or civil penalties shall constitute grounds of forfeiture of the daycare license.

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. Applicant’s email address is already enrolled in the Department’s email notification system. To receive important licensed-related information to licensed facilities,

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
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: ADEN, LUCKY FAMILY CHILD CARE
FACILITY NUMBER: 376629557
VISIT DATE: 02/06/2023
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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.

No corrections are needed. A small license is issued effective today 02/06/2023. The Applicant states they will retrieve the new license from the licensing office when available. Exit interview conducted and report was reviewed with the Applicant Lucky Aden.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC809 (FAS) - (06/04)
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