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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700092
Report Date: 02/17/2022
Date Signed: 02/17/2022 11:40:13 AM

Document Has Been Signed on 02/17/2022 11:40 AM - 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:WHITE FAMILY CHILD CAREFACILITY NUMBER:
197700092
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Earma WhiteTIME COMPLETED:
11:54 AM
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Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Earma White, who guided analyst on a tour of the facility for the One Year Required Inspection. This is a two story 4 bedroom, 3 bathroom home with kitchen, dining room (converted to daycare), family room (converted to daycare), living room, and garage. There is no pool on the premises. Upon arrival LPA observed 2 children. Per licensee they were family members. Per licensee she has 5 children enrolled but has not operated in a week and a half.

Physical Plant: Main care is provided in the converted dining room and family room. Children use the bathroom in hallway near the family room. Children have access to the dining room and family room. Off limit areas include the entire upstairs, kitchen, living room, garage and downstairs bedroom. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (kept under the sink while operating), medicines (inaccessible to children upstairs) and hazardous items (Per licensee no knifes are in the home) that can pose a danger to children. Fireplace is screened. The home has safe and age appropriate toys, play equipment and materials. The carbon monoxide detector, and Fire Extinguisher (3A10BC) are in operable condition. LPA Dorsey found through interview and observation the home did not have a working smoke alarm. Per licensee she does not have the necessary batteries at the time. Stairs have a gate. Per Licensee no one smokes in the home. 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 living room. Per Licensee there are no weapon/firearms in the home.

Per licensee fire/earthquake drills are conducted but not documented, LPA advised licensee that all disaster drills must be logged with the date and time of the drill. Licensee was reminded that disaster drills must be conducted every six months. Per licensee she does not have a children's roster, LPA Dorsey gave licensee an LIC 9040.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 197700092
VISIT DATE: 02/17/2022
NARRATIVE
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Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. Breakfast, AM snack, lunch, PM snack and dinner are provided. Per licensee children's food is not brought from home. 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 currently on the homes kitchen counter due to the licensee rearranging the daycare, per licensee the cleaning supplies are locked under the kitchen sink when children are present.
Outdoor: The backyard has dirt and concrete areas for children to play. LPA observed the toys in the backyard to be in safe condition. While in the backyard LPA Dorsey observed the side gate be broken, per licensee the wind broke the gate and it will be fixed. LPA Dorsey also observed that the left side fence in the backtard is leaning, LPA Dorsey advised licensee that this must be fixed before children can play in the backyard.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expired 01/19/22, Per licensee she will retake the training this week. Per licensee she will send LPA Dorsey a copy of her Mandated Reporter Training when completed. Children nap on mats in the main care are.

Documents discussed: Safe Sleep PIN 20-24-CCP, Small Family Child Care ratios, Children's Roster (LIC 9040) and Parents Rights Form (LIC 995)

Licensee White 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 White 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 White 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: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
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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: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 197700092
VISIT DATE: 02/17/2022
NARRATIVE
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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 Earma White.

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

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/17/2022 11:40 AM - It Cannot Be Edited


Created By: Justin Dorsey On 02/17/2022 at 11:23 AM
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: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 197700092

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/24/2022
Plan of Correction
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Per licensee she will get new batteries for the smoke alarm and send proof to LPA Dorsey by POC due date 02/24/22
Type B
Section Cited
CCR
102417(g)(6)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (6) Outdoor play areas shall be either fenced, or outdoor play areas shall be supervised by the licensee Section 102417(g)(5).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observationthe licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/17/2022
Plan of Correction
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Per licnesee she will fix both gates in the backyard by POC due date 03/17/22
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:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 02/17/2022 11:40 AM - It Cannot Be Edited


Created By: Justin Dorsey On 02/17/2022 at 11:23 AM
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: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 197700092

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 interview and observation, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2022
Plan of Correction
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Per licensee she will take the Pediatric CPR/First Aid training and send proof to LPA DOrsey by POC due date 03/03/22
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:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022


LIC809 (FAS) - (06/04)
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