Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376620015
Report Date: 11/03/2016
Date Signed: 11/03/2016 02:39:19 PM

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:DAWSON, TAMRA FAMILY CHILD CAREFACILITY NUMBER:
376620015
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
11/03/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Tamra DawsonTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Samantha Salunga made an unannounced Annual Random visit and met with Licensee, Tamra Dawson. There were 7 children in care, 4 who are infants. Facility was observed operating over ratio. LPA conducted a tour of the home inside and outside per facility sketch. The entire home is utilized for day care. Outside play area is completely fenced. No body of water was observed during time visit. Business Hours: Monday thru Friday 5:30am-4:30pm.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Home is clean, orderly and has adequate ventilation. Children’s toys and play equipment are available and observed free of hazards. There are no stairs in the home. There is a working telephone/email address. All cleaning compounds, detergents, medications, and poisons are made inaccessible through latches, locks, and/or placed up on high surfaces. Fireplace is inaccessible. Fire extinguisher and smoke detector are operational. Licensee states there are no firearms or other weapons in the home. Children records were reviewed for Emergency Information. 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. Pediatric CPR and First-Aid certificates are valid through 11/2017.

LPA reviewed the following: reporting requirements, regulation highlights, community resources, capacity limitations, supervision, clearances, emergency drills, mandated reporting, SIDS, and Shaken Baby Syndrome. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day care operation.
SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) -767-2200
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: 619-767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2016
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: DAWSON, TAMRA FAMILY CHILD CARE
FACILITY NUMBER: 376620015
VISIT DATE: 11/03/2016
NARRATIVE
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Licensee is aware that interference with a child’s daily functions, physical and mental abuse is not allowed. Licensee is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children. No 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

*** New immunization law (SB792) was discussed with Licensee. Licensee understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza.



See LIC809D for cited deficiency. 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. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.
Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.
SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) -767-2200
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: 619-767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2016
LIC809 (FAS) - (06/04)
Page: 2 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: DAWSON, TAMRA FAMILY CHILD CARE
FACILITY NUMBER: 376620015
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2016
Section Cited
102416.5b1
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For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: four infants.
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Licensee states she understands the staff and ratio regulation for what is allowed at all times. LPA provided Licensee with ratio form. Licensee will submit a letter of her understanding to LPA by POC due date.
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LPA observed 7 children present during time of visit, 4 who are infants. This poses an Immediate Health and Safety risk to the clients 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: Debbie HanesTELEPHONE: (619) -767-2200
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: 619-767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2016
LIC809 (FAS) - (06/04)
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