Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376621279
Report Date: 07/20/2016
Date Signed: 07/25/2016 09:09:35 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:LEBARON, LUCY FAMILY CHILD CAREFACILITY NUMBER:
376621279
ADMINISTRATOR:LUCY LEBARONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 271-6837
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:14CENSUS: 7DATE:
07/20/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Lucy LebaronTIME COMPLETED:
10:50 AM
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LPA Adrian Castellon conducted an unannounced annual/random visit on this date. LPA conducted a tour of the home to ensure the health and safety of children per Title 22 regulations. Licensee is using the following areas for day care: entire first floor. Second floor is properly barricaded and off limits. Fully fenced back yard is used for outdoor play. Drawers and lower cabinets in kitchen/bathroom are either latched or do not contain any hazardous items. Licensee understands that physical discipline/corporal punishment shall never be permitted in the child care operation. There are no bodies of water or weapons maintained at the facility. Fire extinguisher, carbon monoxide detector and smoke detector are present in the home and meet State Fire Marshall standards. Last emergency drill was conducted 06.03.16 and is documented. Forms to be posted are maintained in the home. Reporting requirements were discussed. Licensee’s CPR & First Aid certificate are valid through March 2017. Children's records were reviewed. SIDS and IMS discussed. Licensee is not providing care for children who require IMS. A copy of the roster was obtained. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received clearances or exemptions. Licensee is reminded that all adults with a prominent presence at the facility must be fingerprinted; tuberculosis tested and complete a Criminal Record Statement. There are civil penalties for failure to submit fingerprints. Licensee was advised that upon receipt of a type “A” deficiency, licensee shall post and provide copies of the 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. CCL information and forms can be obtained online at website: http://ccld.ca.gov. NO CITATIONS ISSUED ON THIS DATE.
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: 619-767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2016
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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