<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700070
Report Date: 11/10/2022
Date Signed: 11/10/2022 02:04:24 PM

Document Has Been Signed on 11/10/2022 02:04 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:DAVIS AND MARTIN FAMILY CHILD CARE HOMEFACILITY NUMBER:
197700070
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Venise Davis & Tasha MartinTIME COMPLETED:
02:18 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA's) Justin Dorsey and Joselito Del Mundo met with Licensees, Venise Davis and Tasha Martin, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story 3 bedroom, 2.5 bathroom home with kitchen, dining room, living room, and garage. There is no pool or body of water on the premises. Upon arrival LPA's observed 4 children with the licensees.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway near the home kitchen. Children have access to the living room, children's bathroom, dining room and backyard. Off limit areas include the homes entire upstairs area, kitchen, and garage. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (inaccessible under the sink and garage), medicines (locked under children's bathroom sink) and hazardous items (sharp knives inaccessible in kitchen drawer) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The smoke detector and carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in the living room. Per Licensees there are no weapon/firearms in the home.

The last fire/earthquake drill was completed 02/07/22 (earthquake) 03/20/22 (fire). LPA Dorsey advised licensees that disaster drills must be completed every 6 months. Roster complete and maintained current.

Bathroom: Children's bathroom is free of hazards. Toilet and faucet is clean and operable.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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 2
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: DAVIS AND MARTIN FAMILY CHILD CARE HOME
FACILITY NUMBER: 197700070
VISIT DATE: 11/10/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Kitchen: Sharp utensils are inaccessible. Per licensees breakfast, AM snack, lunch, and PM snack are provided. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are locked under the sink and stored in garage. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children and completely fenced. The backyard has turf for children to play. LPA observed the toys and equipment in the backyard to be in safe condition.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 01/2024. Per licensee sthe Mandated Reporter Training has not been taken. LPA advised licensees to take the training and repeat every 2 years. The training can be found online at www.mandatedreporterca.com. Children nap on mats and in cribs in the living room.

Documents discussed: Safe Sleep PIN 20-24-CCP, LIC 9227 and Infant Sleep Log.

Licensees were 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 licensees 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 licensees 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.

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 the Licensee Venise Davis and Tasha Martin .

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2