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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700579
Report Date: 06/29/2022
Date Signed: 06/29/2022 11:25:21 AM

Document Has Been Signed on 06/29/2022 11:25 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:CORONA FAMILY CHILD CAREFACILITY NUMBER:
197700579
ADMINISTRATOR:MELISSA CORONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 687-1483
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/29/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Melissa CoronaTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Justin Dorsey conducted an announced visit with Licensee Melissa Corona who guided analyst on a tour of the facility for a Pre licensing Inspection. This is a one story home with 4 bedrooms, 2 bathroom with kitchen, dining area, family room, and detached garage. There is no pool/or body of water on the premises. Family members residing in the home include 4 adults (including Licensee) and four children. Days/hours of operation will be Monday through Friday from 07:30 AM to 06:00 PM. The Licensee is relocating her license from, 15455 Glenoaks Blvd. Spc. 217, Sylmar, CA 91342.

Physical Plant: Home is clean and orderly, the home has a fire placed which is properly screened, LPA observed age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, 2A10BC Fire Extinguisher was purchased 05/24/22. Per licensee no one smokes in the home. There is a designated area for ill child(ren) as necessary, no weapon/firearms, facility sketch complete and current, off limit areas include all 4 of the homes bedrooms, 1 bathroom, kitchen and garage. Main care will be conducted in the family room, LPA Dorsey observed adequate toys which are age appropriate and in good condition. There is a working telephone (cell), poisons and cleaning items inaccessible (locked under sink) to children.

Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish, medications (inaccessible in top kitchen cabinet) and chemicals (locked under kitchen sink) are inaccessible. Toilets and faucets are clean and operable.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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: CORONA FAMILY CHILD CARE
FACILITY NUMBER: 197700579
VISIT DATE: 06/29/2022
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Outdoor: LPA Dorsey observed the homes backyard. The backyard includes a concrete which children can play. LPA observed the backyard toys and equipment to be in good condition. The backyard has areas which are made off-limits by fence. The first off-limits area is a planter which runs across the back of the backyard. In this area LPA Dorsey observed plants which included a cactus. LPA observed that this area is made inaccessible by a chicken wire fence. The other off-limits area is located in the back left part of the yard. This area is made off-limits by a gate. In this area there is a ac unit, a shed and a fence which leads to the left side of the home. LPA did not observe any accessible items that could be hazardous to children in care. Per licensee she may conduct outdoor care in the front yard in the future. LPA advised licensee to let licensing know of any changes to the facility sketch.

Advisory/Other: First Aid kit readily available. CPR/First Aid expire 08//2022. The electrical outlets are covered. LPA Dorsey 5 observed cots and a play yard for children/infants to nap. Per licensee the children will nap in the family room area. Licensee reminded to supervise children at all times.

Pets: Per licensee there are no pets in the home. LPA Dorsey did not observe any pets during the visit.

LPA Dorsey advised Licensee all adults living/residing in the home are fingerprint cleared and associated.

Documents Provided and or Discussed: The following were discussed regarding Title 22 requirements: Safe Sleep (PIN-20-24-CCP), LIC 9227, Infant Sleep Log, and IMS policy.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

The following was discussed with the Licensee:

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

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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: CORONA FAMILY CHILD CARE
FACILITY NUMBER: 197700579
VISIT DATE: 06/29/2022
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Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Licensee reminded that 100% supervision is required at all times to children in care; License made aware that it is her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

Licensee advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

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

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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: CORONA FAMILY CHILD CARE
FACILITY NUMBER: 197700579
VISIT DATE: 06/29/2022
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No corrections needed, LPA Dorsey will submit application to Licensing Program Manager upon returning to the office.

Exit interview conducted and a copy of this report was given to Licensee Melissa Corona.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
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