Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304204980
Report Date: 05/06/2016
Date Signed: 05/18/2016 08:23:30 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:RASPPERRY, LAURA ANNFACILITY NUMBER:
304204980
ADMINISTRATOR:RASPPERRY, LAURA ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 871-3653
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:14CENSUS: 8DATE:
05/06/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Licensee- Laura RaspperryTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analyst,(LPA) Moore conducted a Case Management visit at the facility. Present was licensee as well as licensee's husband, and two adult sons. Licensee's 2 adult sons were assisting with 7 day care children upon LPA's arrival. 6 children were playing in the family room with licensee, and assistant and 1 infant was sitting in high chair in kitchen with 1 assistant present. 1 additional child arrived, shortly after LPA's arrival. Census of children was taken as followed: four infants, three were 2 years old, and one was 5 years old. Home was toured inside and outside and files reviewed. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The primary area of day care is the family room redesigned as a playroom and napping room, 2 bedrooms to the left of the hallway have been designated for napping and were equipped with play yards in both rooms. Toys that appear clean, in good condition and age appropriate for ages served are within the playroom. Children receive their meals in the kitchen area. The fire extinguisher, carbon monoxide and smoke detector were in operable condition. Licensee and licensee's adult assistants pediatric CPR and First Aid cards are all current until May 30, 2017. Fire/Disaster drill and facility roster were reviewed.
Latches in place in the bathroom cabinets designated for use by children in care appear in good working order. LPA observed in bathroom drawers which were not latched, 1 container of Medicated Body Powder and 1 tube of Cortisone cream which were both labeled Keep Out of Reach of Children. These hazardous items were accessible to children in care. Licensee immediately removed both of the hazardous items and placed on high shelf, making the items inaccessible to children. The home had an in ground pool in the backyard area with fencing and self-latching gate that meets regulations. Fireplace was screened.
The front yard is fenced and there are toys and outdoor play equipment that appear age appropriate for ages served are located here. Licensee denies firearms on the premises. There are two dogs and two cats in the facility.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2016
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: RASPPERRY, LAURA ANN
FACILITY NUMBER: 304204980
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2016
Section Cited
102417(g)(4)
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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.LPA observed in bathroom drawers which were not latched, 1 container of Medicated Body Powder and 1 tube of Cortisone cream which were both labeled
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Licensee immediately removed both of the hazardous items and placed on high shelf, making the items inaccessible to children.
Licensee will submit letter to LPA Moore how facility will keep hazardous items inaccessibile to children in care. By Due Date of 05/07/16
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Keep Out of Reach of Children.
These hazardous items were accessible to children in care. This may pose an Immediate risk to children in care.
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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: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2016
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: RASPPERRY, LAURA ANN
FACILITY NUMBER: 304204980
VISIT DATE: 05/06/2016
NARRATIVE
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The violations of the California Code of Regulations, Title 22, Division 12, deficiencies were observed and cited on the LIC 809-D page.

“Upon receipt, licensee shall post and provide copies of this report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee is to keep acknowledgement receipt signed by parents in each child’s file.”

An exit Interview was conducted.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. LPA informed the licensee of how to access regulations and forms from CCLD websites: www.ccld.ca.gov or Myccl.ca.gov and/ or http://ccld.ca.gov/PG411.htm. This report is to be on file and accessible for public review at the facility for at least 3 years.

SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3