Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619282
Report Date: 05/24/2017
Date Signed: 05/24/2017 09:46:22 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LAVENANT, OLGA FAMILY CHILD CAREFACILITY NUMBER:
376619282
ADMINISTRATOR:OLGA LAVENANTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 781-5702
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: 7DATE:
05/24/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Olga LavenantTIME COMPLETED:
09:55 AM
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LPA Damian conducted an unannounced Annual Random Inspectionand met with Licensee Lavenant. There were seven children(2 infants and 5 preschool) in care. An additional preschool child arrived during visit. Facility is within ratio and capacity. Assistant is also present. LPA conducted a tour of the home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Licensee is using the following area for daycare; Living room, daycare room, front bedroom and main bathroom. Off-limits areas include; Additional bedrooms and kitchen.

All cleaners, toxins, medications, poisons and other hazardous substances are inaccessible to children in care and are located in off limits area. Licensee has provided safe toys, play equipment and materials. Home is clean, orderly with adequate heating and ventilation for safety and comfort. Primary telephone is a land line which is operational. There are no firearms or other weapons in the home. Fire extinguisher, carbon monoxide detector and smoke detector are present in the home and meet State Fire Marshall standards. Licensee has all appropriate forms posted. There are no existing bodies of water present. Outdoor play area is fenced patio and backyard which is covered and free of hazardous items. All children's equipment is age appropriate and in good condition. Facility has a current roster available for review. Pediatric CPR and First-Aid certificates are valid through April 2018. Last Emergency drill was conducted May 13, 2017. Children’s records were reviewed and contained current immunization records. Licensee has provided parents or representatives with a copy of the Family Child Care Notification of Parent’s Rights. There are no new adults living or working in the home over the age of 18 years. All adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions. Licensee and assistant have both met immunization requirements.

LPA reviewed the following: required departmental documents, supervision, clearances, emergency drills, child passenger law, unusual incidents, mandated reporting, Assembly Bill 633, infant sleeping procedures, SIDS, Shaken Baby Syndrome, and disaster planning. Licensee is reminded that corporal
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2017
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LAVENANT, OLGA FAMILY CHILD CARE
FACILITY NUMBER: 376619282
VISIT DATE: 05/24/2017
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punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation.

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

Exit interview conducted with licensee and appeal rights discussed. Notice of Site Visit posted during inspection and must remain posted for 30 days. No Deficiencies observed during inspection.


SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2017
LIC809 (FAS) - (06/04)
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