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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153908596
Report Date: 06/02/2022
Date Signed: 06/02/2022 04:17:45 PM

Document Has Been Signed on 06/02/2022 04:17 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:VERMILLION FAMILY CHILD CAREFACILITY NUMBER:
153908596
ADMINISTRATOR:VERMILLION, CASSONDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 264-6191
CITY:MOJAVESTATE: CAZIP CODE:
93501
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee Cassondra VermillionTIME COMPLETED:
04:30 PM
NARRATIVE
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On June 2, 2022 at 1:00PM, Licensing Program Analyst (LPA) Brigitte Tsutaoka met with Licensee, Cassondra Vermillion, who guided analyst on a tour of the facility for an Annual Random inspection. This is a single story 2 bedroom, 1 bathroom home with kitchen/dining, living room, family room, and garage. There is no pool/spa or body of water on the premises. Hours of operation are Monday through Friday 4:00AM to 12:00AM. LPA observed 5 children. Family members residing in the home include 1 adult (licensee) and two children. Incidental Medical Services (IMS) policy was discussed.

Main care is provided in living room. Children use the bathroom in hallway. Off limit areas include the both Bedrooms (#1 and #2), garage, kitchen, and family room. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink), medicines (in kitchen cabinet) and hazardous items (sharp knives upper kitchen cabinet) that can pose a danger to children. Fire/earthquake drills complete and maintained current. Roster complete and maintained current. There is AC and heat.

Home is clean and orderly, no fireplace, open face heater non-operational and made inaccessible by gate. Facility has age appropriate toys and play equipment, working smoke detector and carbon monoxide. LPA observed required fire extinguisher (2A10BC). No one smokes in the home, no prohibited items in the home. There is a designated area for ill child(ren) in the living room. Per Licensee, there are no weapons/firearms on the premises. LPA did not observe any at this time. Licensee has working telephone (cell), and understands the facility must have a phone available at all times. Poisons, medication and cleaning items inaccessible to children. Window cords inaccessible.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
Document Has Been Signed on 06/02/2022 04:17 PM - It Cannot Be Edited


Created By: Brigitte Tsutaoka On 06/02/2022 at 03:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: VERMILLION FAMILY CHILD CARE
FACILITY NUMBER: 153908596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by failing to maintain immunization records for herself at the facility, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2022
Plan of Correction
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Licensee agreed to submit copies of immunizations to the Department and retain copies at her facility no later than 07/01/2022.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by failing to maintain updated/renewed CPR/First Aid certification at the faciilty, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2022
Plan of Correction
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Licensee agreed to obtain copies of the renewed CPR/First Aid certification card showing new expiration date no later than 07/01/2022.
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:Carissa Bell
LICENSING EVALUATOR NAME:Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/02/2022 04:17 PM - It Cannot Be Edited


Created By: Brigitte Tsutaoka On 06/02/2022 at 03:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: VERMILLION FAMILY CHILD CARE
FACILITY NUMBER: 153908596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above failing to maintain a copy of the Identification and Emergency Identification (LIC700) in one child's file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2022
Plan of Correction
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Licensee agreed to submit a copy of the completed LIC700 to the Department and maintain a copy in the child's file no later than 07/01/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Carissa Bell
LICENSING EVALUATOR NAME:Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022


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: VERMILLION FAMILY CHILD CARE
FACILITY NUMBER: 153908596
VISIT DATE: 06/02/2022
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Safe and age appropriate toys, play equipment and materials are available to children in care. Electrical outlets are covered. There are no baby bouncers, saucer chairs, or any recalled/prohibited toys or sleep/play equipment observed on the premises. There are age appropriate napping equipment (cots).

Bathroom: Shower/tub free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet are clean and operable.

Kitchen: The following are inaccessible: Sharp items, plastic bags, cleaning items, no chemicals in the kitchen were observed accessible. Cabinets have safety latch. There is a fully stocked refrigerator/freezer. Breakfast, lunch and snacks are served. No food brought observed in refrigerator. LPA provided consultation regarding labeling food brought by parents. Food brought from the children’s home is labelled and dated.

Outdoor: Backyard is inaccessible. Children play in the front yard (gate closed) There are 2 cats, 3 dogs, and 1 puppy at the facility. Play equipment in good repair and anchored to the ground.
First Aid kit was observed with supplies (thermometer) readily available. Licensee has Mandated Reporter (Expires: 03/16/2024). Licensee CPR/First Aid certification expired 06/03/2021 and requires renewal. Licensee disclosed she has the renewal but no longer has the renewal CPR certification card. Licensee does not have liability insurance. Child files reviewed. LPA observed incomplete Identification and Emergency Information (LIC700) in one child file. Required documents posted.

Licensee advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022
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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: VERMILLION FAMILY CHILD CARE
FACILITY NUMBER: 153908596
VISIT DATE: 06/02/2022
NARRATIVE
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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

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, inspect the facility. The Licensee shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022
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: VERMILLION FAMILY CHILD CARE
FACILITY NUMBER: 153908596
VISIT DATE: 06/02/2022
NARRATIVE
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To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Type B violations were cited during inspection. See LIC809D for deficiency details.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with Licensee Cassondra Vermillion.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022
LIC809 (FAS) - (06/04)
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