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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215947
Report Date: 08/09/2022
Date Signed: 08/09/2022 12:19:24 PM

Document Has Been Signed on 08/09/2022 12:19 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:HURSELL FAMILY CHILD CAREFACILITY NUMBER:
406215947
ADMINISTRATOR:KAILA N. HURSELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 674-4631
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Kaila HursellTIME COMPLETED:
12:34 PM
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On August 9, 2022 at 10:27 AM, Licensing Program Analyst (LPA) Frank Pedroza conducted an unannounced Annual/Random inspection. LPA met with Licensee Kaila Hursell and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There was seven (7) children in care and one (1) assistant at the time of the inspection.

Licensee has a two (2) story home. Children have access to the living room, kitchen, bathroom, one (1) bedroom, and backyard. Care for children is primarily provided in the living room and backyard. LPA observed a secured gate at the bottom of the stairs. LPA observed a fireplace in the living room with a screen. LPA did not observe any hazards/toxins accessible to children in care. Licensee stores their disinfectant cleaners under the kitchen sink secured with two (2) types of child safety locks. Licensee has working smoke and carbon monoxide detectors in the home. A 2A10BC fire extinguisher was observed mounted on the wall in the hallway readily accessible. LPA observed age appropriate toys and activities readily accessible for children in care in side the home. The backyard is enclosed with a wood fence. Licensee has age appropriate toys and play structures readily accessible for children in care. Licensee does have firearms and live ammunition properly secured out of reach of children in care. Licensee is provided Incident Medical Services (IMS) and properly storing the medication readily accessible.

LPA reviewed a sampling children and staff records. Children files were found to be current and complete. Staff files were found to be current and complete. Staff have current Pediatric CPR/First-Aid certificates that expire on 3/26/23. Both licensee and assistant have current Mandated Reporter certificates. LPA spoke with licensee about current Covid-19 requirements. Licensee is following current guidelines.

No deficiencies were cited during today's inspection.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HURSELL FAMILY CHILD CARE
FACILITY NUMBER: 406215947
VISIT DATE: 08/09/2022
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.



Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee 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 licensee [facility representative] 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
LIC809 (FAS) - (06/04)
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