197700092-3-1-2023-12-CC-JDOY-CPHRCH-20230301115421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700092
Report Date: 03/01/2023
Date Signed: 03/01/2023 11:54:27 AM

Document Has Been Signed on 03/01/2023 11:54 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 CARE		FACILITY NUMBER:	197700092
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	03/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Earma White		TIME COMPLETED:	12:09 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 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, family room, living room, and garage. There is no pool on the premises. Upon arrival LPA observed 1 child with the licensee. Physical Plant: Main care is provided in the family room. Children use the bathroom in hallway near the homes downstairs bedroom and garage. Children have access to the family room, children's bathroom, dining room downstairs bedroom and backyard. Off limit areas include the entire upstairs living room, 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 (locked under the sink), medicines (per licensee there are no medications in the home) and hazardous items (sharp knives inaccessible in top kitchen cabinet) 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 living room. Per Licensee there are no weapon/firearms in the home. During the visit LPA Dorsey observed outside panel of the double panel window in the living room was broken. See attached Type B citation for details. The last fire/earthquake drill was completed 02/02/23. Roster complete and maintained current. Bathroom: Shower is free of hazards (child care bathroom). Toilet and faucet is clean and operable.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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 03/01/2023 11:54 AM - It Cannot Be Edited

Created By: Justin Dorsey On 03/01/2023 at 11:10 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: 03/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(d)

Operation of A Family Child Care Home

(d) The home shall provide safe toys, play equipment and materials. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the outside panel of the living rooms double panel window was broken, 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: 03/10/2023
	Plan of Correction
1 2 3 4	Per licensee she will replace the window and send LPA Dorsey proof by POC due date 03/10/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 03/01/2023

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Kitchen: The kitchen is made inaccessible by gate. Sharp utensils are inaccessible. Per licensee breakfast, AM snack, lunch, PM snack and dinner 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. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard was inspected. The backyard is completely fenced children will play outside in the backyard. There is concrete and dirt for children to play. LPA observed toys and play equipment in good condition. LPA Dorsey observed right side of the backyard to made off-limits by gate.

Advisory/Other: First Aid kit was readily available. CPR/First Aid expire 06/23/24. Mandated Reporter was completed 03/23/22. Children nap on mats and cribs in the family room.

Documents discussed: Title 22 Personnel Records 102416.1, IMS FCCH Reference Guide, Safe Sleep PIN 20-24-CCP, LIC 9227, Infant Safe Sleep Log.

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.

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: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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