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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700183
Report Date: 06/10/2021
Date Signed: 06/10/2021 01:48:42 PM

Document Has Been Signed on 06/10/2021 01:48 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:MITCHELL, VETIA FAMILY CHILD CAREFACILITY NUMBER:
197700183
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Vetia MitchellTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) King-Lewis conducted a required 1 year Inspection with licensee Vetia Mitchell, who guided analyst on a tour of the license day-care. The day care take place in the following area of the home: playroom/bedroom #1, den, kitchen area, bathroom, and rear-yard. The off limit areas for the day-care are the entire of stairs and the living room. There is no pool/spa on the premises. Family members residing in the home include two adults (Applicant and adult son). Days/hours of operation will be Monday through Sunday less than 24 hours as needed.

Physical Plant: no bodies of water on premises, no firearms or other dangerous weapons. storage areas for poisons shall be inaccessible to children and locked. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are inaccessible to children. Fireplace is screened, fire extinguishers, smoke detectors, and carbon monoxide appear to be operable. LPA observed the home to be clean and orderly, central air and heating available. LPA observed the stairs are barricaded, licensee stated a land line telephone and cell phone will be available, charge during day-care hours. Licensee has a play yard for infant use, with firm mattress, licensee stated when infants are present the play yard is free from all loose articles and objects.



Care and Supervision
Licensee is aware she must be present in the home and shall ensure that children in care are supervised at all times. Licensee stated she do not provide transportation at this time but is aware not child shall be left in parked vehicles. Licensee is aware the capacity stated on the facility license shall be the maximum number of children being cared for. Licensee aware no infant shall be
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2021
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: MITCHELL, VETIA FAMILY CHILD CARE
FACILITY NUMBER: 197700183
VISIT DATE: 06/10/2021
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swaddled and car seat shall not be use for sleeping. Licensee is aware to supervise infants while they are sleeping by physically checking every 15 minutes and documenting the child status. Licensee should refer to regulation 102425(J) for documentation requirement. LPA reviewed requirement with licensee.

Facility Records Review
LPA observed facility current roster of children, current fire and disaster drill, current mandated reporter expires 05-07-2022, licensee immunization are current and licensee is aware that all employees or volunteer at the day-care shall be immunized against pertussis and measles and maybe immunized against influenza. Licensee stated at this time no infants are in care. Licensee is aware all infants shall have an individual infant Sleeping Plan (LIC 9227).

Facility Administration
Licensee aware she shall immediately remove the individual and prevent the individual for returning to the home or having contact with children in care upon notice from the department to remove a individual and all individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in the license home. Licensee is aware any authorized employee of the Department may enter and inspect any place providing personal care and services at any time with or without advance notice. Licensee is aware other personnel shall complete training on preventive health practices including CPR and first aid per regulation 102416 (c).

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B per the regulation.

During this inspection facility was observed to be in compliance with Title 22.

An exit interview was conducted, and a copy of this report and the notice of site visit, provided to licensee on this date.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
LIC809 (FAS) - (06/04)
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