426215921-5-9-2023-17-CC-EBAY-CRNTEW-20230509144037

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215921
Report Date: 05/09/2023
Date Signed: 05/09/2023 02:42:38 PM

Document Has Been Signed on 05/09/2023 02:42 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:	LONG FCC AKA SMALL HOME DAYCARE		FACILITY NUMBER:	426215921
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	05/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Kolby Long		TIME COMPLETED:	03:00 PM

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 May 9th, 2023 at 12:45 PM, Licensing Program Analysts, (LPAs) Elvin Baddley and Dixie Wright conducted an unannounced Required one year inspection. LPAs met with licensee, Kolby Nicole Long and discussed the purpose of the inspection. During the inspection licensee was caring for four children, all infants. LPA in the company of Licensee toured the interior and exterior of the day care. Family Child Care Home (FCCH) uses the living room, dining room, backyard and bathroom. LPA observed required licensing forms are posted in the dining room. LPA observed smoke and carbon monoxide detectors in the FCCH, which were tested and functioning. The regulation fire extinguisher was purchased on 12/20/2022. The play yard is enclosed by a cinder block fence. LPA observed age appropriate toys. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home. LPAs reviewed facility file, Pediatric CPR and First Aid expires 02/22/24 Licensee has taken the Mandated Reporter Training per AB 1207, expires 08/05/2024. Last fire drill was done 05/08/23. Licensee has proof of immunization on file. FCCH conducts fire and disaster drill every month. FCCH has current roster of children in care. A sampling of children records was reviewed and found to be current. File contains Emergency and Identification card requirements. Licensee carries liability insurance for Day Care business. During today's inspection, no deficiencies were cited. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LONG FCC AKA SMALL HOME DAYCARE	FACILITY NUMBER: 426215921
	VISIT DATE: 05/09/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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.

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 website www.cdss.ca.gov/inforesources/community-care-licensing/process.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA 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 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.

A notice of site visit was given and must remain posted for 30 days. Report was reviewed and exit interview was conducted with Licensee, Kolby Long.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

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