197700070-5-13-2024-12-CC-MRIA-D58UE4-20240513153031

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700070
Report Date: 05/13/2024
Date Signed: 05/13/2024 03:30:47 PM

Document Has Been Signed on 05/13/2024 03:30 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	DAVIS AND MARTIN FAMILY CHILD CARE HOME		FACILITY NUMBER:	197700070
ADMINISTRATOR/ DIRECTOR:	VENISE DAVIS, TASHA MARTIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 967-8604
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	05/13/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:10 PM
MET WITH:	Venise Davis and Tasha Martin, Licensees		TIME VISIT/ INSPECTION COMPLETED:	03:45 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	On Monday, May 13, 2024, at 1:10 p.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with licensees Venise Davis and Tasha Martin who guided LPA Rivera on a tour of the facility. During this inspection, 6 children (2 toddlers and 4 preschoolers) were present. Family members residing in the home was discussed with licensees and are background cleared. Operating hours are Monday to Friday, 7:00 a.m. to 5:00 p.m., and care for children ages 0 to 12 years. All areas identified on the facility sketch were inspected by LPA Rivera. This is a two-story home which consists of three bedrooms, three bathrooms, kitchen, living room, garage, and back patio. Areas that are accessible to children and identified on the facility sketch include: living room, bathroom (1^stfloor) and back patio. Areas off limits to children include: all second floor- three bedrooms and 2 bathrooms, kitchen, and garage. LPA observed a gate barrier in place below the stairs, between the living room and main entrance walkway, kitchen, and hallway to prevent children going into the off-limit areas. LPA observed license, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch and license posted near the main entrance area. LPA also reviewed Child Care Facility Roster and children records.. At approximately 1:45 p.m. LPA Rivera, inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone and land line). For ventilation, LPA observed central AC/heater and vents located on the ceiling. LPA Rivera observed the furniture, children’s materials, and cots to be age appropriate and in good condition. LPA observed two play yards and observed the play yards to have a fitted mattress with a

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME	FACILITY NUMBER: 197700070
	VISIT DATE: 05/13/2024

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fitted sheet and free from bumper pads, pillows, blankets, and hanging items. LPA did not observe pacifiers.

At approximately 1:55 p.m., LPA observed cleaning compounds items stored inside the bottom kitchen sink cabinet with a child proof lock in place making it inaccessible to children to open. Knives and sharp objects are stored in the kitchen drawer. For drinking water, LPA observed water dispenser and disposable cups. Licensees provides the meals and LPA informed if food is brought from children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. During this visit licensees stated currently have no children with food allergies or prescribed or non-prescribed medication. For ill isolation area, the corner of the living room near the entrance is utilized.

LPA Rivera asked if there are any pets, poisons, firearms, weapons, or bodies of water. Licensees stated they have one Australian shepherd, poisons are stored in the locked garage, and the community pool is located at the end of complex (not near the home) inaccessible to children and no firearms, or weapons. LPA did not observe the dog, firearms, or weapons. LPA observed the community pool to be at the end of the complex away from the home and gated. LPA observed the poisons, to be stored in the lock garage. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition/pins must be stored separately.

At approximately 2:01 p.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the kitchen and the valve on the green area indicating fully charged. LPA observed purchase receipt dated 8/21/2023. LPA observed carbon monoxide detector and the smoke detector located near the main entrance. LPA Rivera tested the carbon monoxide and the smoke detector. Carbon and smoke detectors are operable. LPA observed the first aid kit complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the bathroom. LPA observed the earthquake and fire drill log dated 2/18/2024.

LPA Rivera entered the bathroom and observed the toilet, running water, hand soap and paper towels. Inside the bottom cabinet, LPA did not observe items that can pose a potential hazard to children and observed the cabinet with a childproof lock. LPA observed the bathroom to be in good condition.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME	FACILITY NUMBER: 197700070
	VISIT DATE: 05/13/2024

NARRATIVE

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LPA inspected the outdoor area (patio) used by children for safety, comfort and cleanliness, LPA observed the patio to be fenced all around and the side gate closed, and a gate barrier installed to prevent children going to the side yard. LPA observed the play equipment to be age appropriate, in safe condition, free of sharp, no loose or pointed parts. LPA observed the AC compressor and advised to place a mesh cover on top where the fan is located to prevent children placing their fingers. Children bring out their water bottles.

LPA observed licensees incorrect BLS CPR certification dated 12/16/2023. LPA informed the required certification is the Pediatric First Aid, CPR certification. Licensees enrolled for the required Pediatric First Aid/CPR 5/18/2024. LPA observed licensees Health and Safety certification dated 9/16/2017 and have proof of immunization against Pertussis, MMR and Influenza. Licensees have completed the mandated reporter (AB 1207) training dated 8/8/2023.

The following was also discussed with licensee:

1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2 Pediatric First Aid and CPR: American Heart Association or American Red Cross or Emergency Medical Services Authority (EMSA) approved in Pediatric First Aid and CPR must be present. Certification must be renewed every two years.
3. Licensee was informed that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

4. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.

5. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME	FACILITY NUMBER: 197700070
	VISIT DATE: 05/13/2024

NARRATIVE

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6. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated

7. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

8. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

9. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B).

10. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

11. Smoking is prohibited in the family childcare home.

12. Children and staff records must be maintained and updated as needed and be available for review by the Department.

13. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

14. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

15. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME	FACILITY NUMBER: 197700070
	VISIT DATE: 05/13/2024

NARRATIVE

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16. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

17. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

18. Dog(s) and/or pets are recommended to be isolated from children in care.

19. No, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee Tasha Martin. was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Tasha Martin and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Tasha Martin 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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: DAVIS AND MARTIN FAMILY CHILD CARE HOME	FACILITY NUMBER: 197700070
	VISIT DATE: 05/13/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee Tasha Martin was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee Tasha Martin confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No citations during this inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted, and report was reviewed with the licensee Tasha Martin.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

LIC809 (FAS) - (06/04)

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