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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216472
Report Date: 11/09/2022
Date Signed: 11/09/2022 05:43:20 PM

Document Has Been Signed on 11/09/2022 05:43 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:LAKEMAN FAMILY CHILD CAREFACILITY NUMBER:
406216472
ADMINISTRATOR:LEENTJE LAKEMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 382-9275
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/09/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Leentje LakemanTIME COMPLETED:
06:00 PM
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This is a change of location, previous facility number 406214193.

Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On November 11, 2022, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced change of location, Pre-licensing inspection for a Large Family Child Care Home (FCCH) license. LPA met with Leentje Lakeman, Applicant, and discussed the purpose of today’s visit. LPA and Applicant together toured the inside and outside of the home. There were no children in care at the time of the inspection.

Applicant requested a change of location for a large family childcare license. The home is a three (3) bedroom, three (3) bathroom home. LPA notes that the day care area is separate from the main home. The applicant will be using the daycare room and outdoor play area for childcare services.

LPA observed the daycare room is fully equipped to meet the needs of children in care. LPA observed the kitchen area to be off-limits by means of a baby gate and office space that is also inaccessible by means of a gate.

LPA observed that the FCCH is clean and orderly. In addition, there is plenty of ventilation for the children in care. LPA did not observe any toxins nor hazards items accessible to children in care. LPA observed that knives are stored in a locked cabinet in the kitchen that is inaccessible to children. Detergents and cleaning compounds were observed under the sink of the kitchen and under the sink in the bathroom. LPA notes both areas are locked and inaccessible to children in care. The bathroom to be used for children in care was observed to be clean and free of toxins.

LPA notes this home as a big back yard and only part of the outdoor yard will be accessible to children in care. The back yard has age-appropriate toys and day-care equipment. LPA observed child size furniture and material for activities throughout the home in areas that will be accessible to children in care. LPA an Applicant discussed the importance of active supervision when children are outdoors. CONT 8909-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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: LAKEMAN FAMILY CHILD CARE
FACILITY NUMBER: 406216472
VISIT DATE: 11/09/2022
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There will be one (2) adult living in the home. Adults are fingerprint cleared.

LPA observed a regulation 2A10BC fire extinguisher in the FCCH at the time of the inspection that was purchased on September 10, 2022. Licensee is reminded to service or purchase the fire extinguisher yearly. LPA observed licensee test both smoke and carbon monoxide detectors in the home at 5:00 PM and were functioning at the time of the inspection.

This home received a fire clearance from Atascadero Fire Department on October 21, 2022.

No bodies of water were observed. Licensee stated that there are no weapons or ammunition in the home. Licensee stated she does not hold a foster family license. Licensee is current with immunization required per SB 792.

Licensee Pediatric First Aid/CPR certificate is valid until November 4, 2024. Licensee completed the Mandated Reporter Training on April 24, 2021, that is required per AB 1207. Control of property was verified via review of mortgage deed.

LPA discussed Incidental Medical Services with the licensee. Incidental Medical Services (IMS) policy was discussed. 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: htttp://www.ada.gov/childqanda.htm

LPA reviewed and provided the handout "A Child Care Provider's Guide to Safe Sleep" (PIN 20-24-CCP), Effects of Lead Exposure, What is Carbon Monoxide, and Self- Assessment. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided online at www.ccld.ca.gov.



This home meets Title 22 Division 12 requirements of a Large FCCH license. Effective date of license will be noted as the present, November 11, 2022.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
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