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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840301
Report Date: 06/14/2021
Date Signed: 06/14/2021 02:29:59 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/14/2021 02:29 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BOUCHEY FAMILY CHILD CAREFACILITY NUMBER:
364840301
ADMINISTRATOR:BOUCHEY, STEPHANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 954-4446
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 13DATE:
06/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Stephanie BoucheyTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Thompson-Miller met with Licensee, Stephanie Bouchey, who guided analyst on a tour of the facility for an One Year Required inspection. This is a two story 5 bedroom, 3 bathroom home with kitchen/dining, family room, formal dining room, living room, laundry and garage. There is no pool/spa or body of water on the premises. Family members residing in the home include 1 adult (licensee) and two children. Upon arrival LPA observed 13 children in care (5 preschool, one infant, 7 school age) along with licensee assistant and licensee. Licensee is also a foster parent. Days/Hours of operation are Monday to Friday, 7:00AM-5:00PM (summer hours), regular hours are Monday through Sunday 7AM to 5AM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: The home is clean and orderly. The home entrance is through the front door. Main care is provided in the living and formal dining rooms and Bedroom #1 (downstairs). Children use the bathroom in hallway. Off limit areas include the entire upstairs (Bedroom #2 , #3, #4, #5/office, bathroom #2 and #3), laundry (washer and dry are locked) and garage (key lock). Per licensee, the garage will be used for activities only (no eating or sleeping) since 6/22/19. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (garage cabinet with magnet lock), medicines (upstairs, kitchen cabinet with magnet lock) and hazardous items (sharp knives in upper cabinet of kitchen-magnet lock) that can pose a danger to children.
Fire/earthquake drills complete and maintained current. Roster complete and maintained current. Stairs have a gate. Per Licensee, there are no weapons or firearms on the premise. LPA did not observe any in the home.
The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. The facility sketch is complete and current, there is a working telephone (land line and cell).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: BOUCHEY FAMILY CHILD CARE
FACILITY NUMBER: 364840301
VISIT DATE: 06/14/2021
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 Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet is clean an operable and home has a refrigerator/freezer clean. No chemicals in the kitchen were observed to be accessible. Breakfast, lunch, snacks and dinner will be provided. Hazardous items (sharp knives above the stove) that can pose a danger to children are inaccessible. Cabinets in the kitchen have magnet locks.

Home has central AC and heat. CPR/First Aid expired 10/27/2020. Licensee is registered and paid for class which will be conducted today (LPA observed receipt). The First Aid kit was observed.

Outdoor: Backyard (rear and left side) off limits. The backyard is completely fenced. There is no swing/slide. No pets. The left side is gated (separate-wrought iron with gate). There are age appropriate toys. Age appropriate napping (playpen, cots) equipment.

Advisory/Other: First Aid kit was observed with supplies readily available. Lead Poison flyer was provided to Licensee.

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

Documents Provided and or Discussed: LPA observed the following: COVID-19 posters, Lead Flyer, Safe Sleep, Seat Belt Safety



All adults living/residing in the home are fingerprint cleared and associated.

No deficiencies. Exit interview conducted and a copy of this report was read and provided to Licensee, Stephanie Bouchey.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
LIC809 (FAS) - (06/04)
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