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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216472
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:59:21 PM

Document Has Been Signed on 09/10/2024 03:59 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/
DIRECTOR:		LEENTJE LAKEMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 382-9275
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Leentje LakemanTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On 9/10/24, at 11:30 AM, Licensing Program Analysts (LPAs) Elvin Baddley and Shane Loftus conducted an unannounced Annual/Random inspection of the abovementioned Family Child Care Home (FCCH). LPAs met with Leentje Lakeman, Licensee of the FCCH and explained the nature and purpose of the inspection.
LPAs, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH is a three bedroom, three bathroom home, single story dwelling which sits on four acres. LPAs notes the day care area is separate from the main home. The Licensee uses the daycare room and outdoor play area for childcare services. LPAs observed six children on site, along with an Assistant (cleared and associated) providing care and supervision.

The FCCH was observed to be clean and orderly. The FCCH has ventilation to afford for the children’s comfort. Medication, cleaning compounds and sharps are located in the excluded area of the FCCH and inaccessible to children in care. Required forms are predominantly posted on the wall in the kitchen area. There is no fireplace in the daycare area, but the home's main residence does contain have fireplace, which is inaccessible to children in care. The FCCH's restroom used for child care services is observed to be clean and free of toxins. LPAs observed a combination smoke and carbon monoxide detector in the daycare area which was tested at 1:00 PM and found to be operable.The FCCH has a regulation fire extinguisher on site which was purchased on 9/8/24. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services.

The outdoor play area is not enclosed by fencing. At 1:20 PM, LPAs observed a grassy slope descending to a dry creek area. The grassy slope varied in proximity to the children's play structures from 10 feet to 20 feet in certain areas. LPAs discussed the slope degrade with the Licensee. The Licensee informed LPAs the creek area does seasonal fill with water. LPAs informed Licensee of the need for a fence to be in place so children do not access the descending slope or creek (the potential water hazard). At 1:26 PM, LPAs observed a (CONT. 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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 6
Document Has Been Signed on 09/10/2024 03:59 PM - It Cannot Be Edited


Created By: Elvin Baddley On 09/10/2024 at 01:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LAKEMAN FAMILY CHILD CARE
FACILITY NUMBER: 406216472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/interview, the licensee did not comply with the section cited above in that children in care have access to an above ground swimming pool, without proper fencing/cover, which poses an immediate health, safety or personal rights risk to persons in care. Civil Penalty of $500 assessed.
POC Due Date: 09/11/2024
Plan of Correction
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Licensee to have swimming pool fenced per regulations or removed by the closed of business (5:00 PM) on 9/11/24. Proof of correction (photograph) to be submitted to CCLD (elvin.baddley@dss.ca.gov) by the closed of business (5:00 PM) on 9/11/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Elvin Baddley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 09/10/2024 03:59 PM - It Cannot Be Edited


Created By: Elvin Baddley On 09/10/2024 at 01:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LAKEMAN FAMILY CHILD CARE
FACILITY NUMBER: 406216472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/interview, the licensee did not comply with the section cited above in that children in care have access an (adult) trampoline which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2024
Plan of Correction
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Licensee to have trampoline securely netted or removed by the closed of business (5:00 PM) on 9/24/24. Proof of correction (photograph) to be submitted to CCLD (elvin.baddley@dss.ca.gov) by the closed of business (5:00 PM) on 9/11/24.
Type B
Section Cited
CCR
102417(g)(6)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (6) Outdoor play areas shall be either fenced, or outdoor play areas shall be supervised by the licensee Section 102417(g)(5).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/interview, the licensee did not comply with the section cited above in that children in care have access a slope which descends to a dry creek (seasonal creek filled with water) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2024
Plan of Correction
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Licensee install fencing in front of the grassy slope degrade by the closed of business (5:00 PM) on 10/1/24. Proof of correction (photograph) to be submitted to CCLD (elvin.baddley@dss.ca.gov) by the closed of business (5:00 PM) on 10/1/24..
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Elvin Baddley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/10/2024 03:59 PM - It Cannot Be Edited


Created By: Elvin Baddley On 09/10/2024 at 01:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LAKEMAN FAMILY CHILD CARE
FACILITY NUMBER: 406216472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/interview/ record review, the licensee did not comply with the section cited above in that Licensee does not have current Mandated Reporter Training certification (4/24/23, expiration) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2024
Plan of Correction
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Licensee to submit Mandated Reporter Training Certification to CCLD by the closed of business (5:00 PM) on 9/24/24. Proof of correction (photograph) to be submitted to CCLD (elvin.baddley@dss.ca.gov) by the closed of business (5:00 PM) on 9/24/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Elvin Baddley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


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: 09/10/2024
NARRATIVE
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trampoline outside of the FCCH. LPAs observed no netting or lock on the trampoline. LPAs informed the Licensee of the need to have the trampoline inaccessible to children in care.

At 1:30 PM, LPAs observed an above ground swimming pool. It should be noted the swimming pool outside of the FCCH was not covered or fenced. Further, there was nothing on site which served as a barricade to the swimming pool or the swimming pool area. LPAs informed the Licensee of the swimming pool requirements for FCCH. Aside for the aforementioned LPAs observed age appropriate plays structures and furnishings.

LPAs reviewed children's records. The records are current, complete and possessed emergency contact information and immunization records, among other required licensing documents and forms. A review of the FCCH's fire drill log reveals fire drills are current with the last fire drill on site occurred on 8/7/24. The Licensee's records are reviewed. At 1:50 PM, LPAs were unable to find a current Mandated Reporter training certification for the Licensee. LPAs reminded Licensee to renew certifications and training prior to expirations. The Licensee informed LPAs no firearms or ammunition are stored on site.

The Licensee does not provide Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.



LPAs 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. LPAs also informed Licensee 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.

Licensee 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a
(CONT. 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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: 09/10/2024
NARRATIVE
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repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS on 9/10/24.

Type B Deficiencies are being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations and HSC 1596.8662(b)(1), CCR 102417(g)(4) and CCR 102417(g)(6) (refer to LIC 809-D). Licensee was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A Type A Deficiency is being cited based on LPA’s observation/interviews pursuant to Title 22 of the CA Code of Regulations and CCR 102417 (g)(5) (refer to LIC 809-D). Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents/guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.



A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Leentje Lakeman.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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