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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700092
Report Date: 05/18/2022
Date Signed: 05/18/2022 02:40:38 PM

Document Has Been Signed on 05/18/2022 02:40 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:WHITE FAMILY CHILD CAREFACILITY NUMBER:
197700092
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
05/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Earma WhiteTIME COMPLETED:
02:55 PM
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On 05/18/22 Licensing Program Analysts (LPA's) Justin Dorsey and Justeene Tamayo conducted an Inspection at White FCC. The purpose of the inspection was a Plan of Correction to review the deficiencies cited on 02/26/22. LPA Dorsey met with licensee Earma White and toured the facility. The following was observed:

1.) LPA's observed that the homes backyard fence along the bac leftt side of the yard was fixed. LPA's also observed that the gate leading to the front yard is still not able to lock. LPA informed licensee that due to the gate not being able to lock, 100% supervision must be provided while the children are in the backyard.
2.) LPA's observed that the homes smoke detector was in operable condition.
3.) LPA's found during interview that the licensee has not completed a CPR/First Aid Training. Per licensee she is scheduled for a training on 06/04/22.

Exit interview conducted a copy of this report, Notice of Site Inspection and Deficiency Clearance Letter was left with Licensee Earma White.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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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Document Has Been Signed on 05/18/2022 02:40 PM - It Cannot Be Edited


Created By: Justin Dorsey On 05/18/2022 at 01:46 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: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 197700092

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2022
Section Cited
CCR
102416(c)

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102416 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:
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Per licensee she has an appointment for the CPR class on 06/04/22. Per Licensee she will take the class and send proof to LPA Dorsey by POC due date 06/06/2022.
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Based on interview the licensee has not completed the CPR/First Aid Training which poses a potential Health, Safety or Personal Rights risk to children in care.
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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: 05/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022


LIC809 (FAS) - (06/04)
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