Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360909943
Report Date: 05/04/2018
Date Signed: 05/04/2018 03:26:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:AMERSON FAMILY DAY CAREFACILITY NUMBER:
360909943
ADMINISTRATOR:AMERSON, DEBBIE S.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 241-6302
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 9DATE:
05/04/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Debbie S. AmersonTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Neal met with licensee, Debbie Amerson, for the purpose a Annua/Random inspection. Family members residing in the home include licensee and her husband. This is a single story 5 bedroom, 2 bathroom home with kitchen, living room, family room, dining room, backyard, and garage. The garage is used for storage and laundry only and no child care activities are conducted there. During this inspection, there were 9 child care children, licensee and her husband (assistant). Incidental Medical Services (IMS) were discussed.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds , medicines, and hazardous items that can pose a danger to children. Child care is provided in the family room and living room. Children use the bathroom located down the hall. Off limits areas include all the bedrooms, master bedroom/bathroom, and the garage. Sharp knives located in an upper kitchen cabinet above the refrigerator. Facility roster is complete and maintained current. Fire/earthquake drills are also current.

Children play in the backyard. There is a pool on the premises with a self-latching, self-closing gate that is of appropriate height. There are grass, sand and concrete areas for active play. There are swings, 2 small play structures, a sandbox and other age appropriate toys.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: AMERSON FAMILY DAY CARE
FACILITY NUMBER: 360909943
VISIT DATE: 05/04/2018
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Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. LPA observed age appropriate toys and napping equipment on the premises. There are mats available for napping children. The required fire extinguisher, smoke detector and carbon monoxide detectors are in operable condition. Fireplace is properly screened. Home has central AC and heat. CPR/First Aid expires 09/2018. First Aid kit was observed and is stored above the refrigerator. Mandated Reporter training has been completed (certificate dated 1/3/2018).
The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is required at all times to children in care. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12 month period, PER PERSON.
To receive the quarterly updates on Community Care Licensing by email, please send your request to: Childcareadvocatesprogram@dss.ca.gov
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: AMERSON FAMILY DAY CARE
FACILITY NUMBER: 360909943
VISIT DATE: 05/04/2018
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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 Homes 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
Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.
Licensee informed to review all updates/regulations on the department website. Licensee advised to review Quarterly Updates which include information on: AB 1207 - all child care employees must complete mandated reporter training beginning January 2018; AB 1387 - process to request a formal review of deficiency and establishes an appeal process for civil penalties; SB 277 - require all children attending day care or school based programs to be immunized and will eliminate personal/religious belief exemptions; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles.
The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).
No deficiencies were cited during this inspection.
An exit interview was conducted and a copy of this report was provided to the licensee on this date.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2018
LIC809 (FAS) - (06/04)
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