304314103-10-26-2022-06-CC-MMAK-CKKN8K-20221026101427

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314103
Report Date: 10/26/2022
Date Signed: 10/26/2022 10:14:38 AM

Document Has Been Signed on 10/26/2022 10:14 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	MORRIS, MARIA		FACILITY NUMBER:	304314103
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/26/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicant, Maria Morris		TIME COMPLETED:	10:45 AM

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	Page 1 Licensing Program Analyst LPA) Mahnaz (Nancy) Malek conducted an announced In-person pre-licensing inspection for a new small family childcare home. LPA met with applicant, Maria Morris who is a resident of this home. LPA was given a tour of the house. There were no children present. A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared. Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes, to notify the licensing office. Applicant is requesting for a Small Family Childcare Home license. Operation hours will be Monday to Sunday from 6:00 AM to 5:00 AM (less than 23 hours) and care and supervision will be provided to children ages birth to 13 years old. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single home story that consists of 4 bedrooms, 2 restrooms, family room,(Den) living room, kitchen, laundry room, Front yard, backyard and a garage. There is no stairway or fireplace in the home. Areas that will be used by children were inspected for safety, comfort, cleanliness, ventilation and heating. Telephone service (The land line phone is the primary contact phone) . Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children stored in the locked garage and top cabinets. The Licensee states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock. Continued on page 2

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MORRIS, MARIA	FACILITY NUMBER: 304314103
	VISIT DATE: 10/26/2022

NARRATIVE

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Based on the Facility Sketch submitted, areas off limits to children and parents are: Two bedrooms / laundry room and garage, which are made inaccessible by installation of a child proof doorknobs. Maria Morris understands that licensing staff may have access to off-limit areas during inspection visit if necessary.
Areas Designated for Day care activities: Applicant has designated living area, family room (Den) two bedrooms in front of the living area (One on the right side and one on the left side ) Bedroom on the right has an attached bathroom that is designated for children’s use. Kitchen is open and the cabinets are made inaccessible by child stopper locks. Children shall enter the home through the front entrance, they walk through the living area of the home, this area is used by children. The bathroom designated for day care use is located in the right-hand bedroom and was observed to be safe free of hazardous items. Bathroom was clean. The two bedrooms are mainly used during nighttime care and nighttime sleep regulations were discussed with Maria Morris. A written plan for supervision during nighttime care has been submitted to our Department.

The bedrooms were observed to have age appropriate bed with proper linens and blankets. Family room area is activity room with age appropriate toys and educational items for children.
The two designated rooms were observed to have age appropriate furniture, toys and educational materials for children in care.

OUTDOOR PLAY AREA: Backyard is designated for outdoor play area, it is fenced and has concrete and grassy area, it has age appropriate outdoor toys and climbing structures. Maria Morris was advised to make sure there are cushioning materials underneath the falling zones of the climbing structure. Front yard is also used for outdoor activities. Front yard is not fenced but their is ongoing supervision provided by adult staff member at all times when children are present.

There are three dogs living in the house (Yorkies Breed).
There are no firearms, weapons or bodies of water on the premises.
The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MORRIS, MARIA	FACILITY NUMBER: 304314103
	VISIT DATE: 10/26/2022

NARRATIVE

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The following was discussed with Maria Morris: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.
Civil Penalties will be assessed if not in compliance.
In the absence of the licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.
Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
Applicant was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, no infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MORRIS, MARIA	FACILITY NUMBER: 304314103
	VISIT DATE: 10/26/2022

NARRATIVE

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UPDATE: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The applicant has submitted proof of immunization's.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

Applicant has completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is valid through 6/2024.

A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:

English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

LPA reviewed with applicant, Maria Morris the following safe sleep best practices:

*Always place infants on their backs for sleeping
*Use only a tight-fitting sheet on the crib or play yard mattress
*Do not hang any items from the crib or above the crib
*Keep all items, including blankets, out of the crib or play yard
*Pacifiers may be used as long as they do not have items attached to them
*Infants should not be swaddled or have any items covering them while sleeping
*The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold
Every 15 minutes check on napping children under 24 months on the log was discussed with the applicant.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MORRIS, MARIA	FACILITY NUMBER: 304314103
	VISIT DATE: 10/26/2022

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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

Licensee will provide AM/PM snacks and parent provide lunch to children. If food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

Upon entrance through the designated main door of the home, applicant shall receive the children here, due to pandemic parents are encouraged to follow CDC guidelines,

OTHER INFORMATION AND FORMS PROVIDED to Maria Morris

Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

Maria Morris was reminded to associate and adults with a clearance ID # to her facility, she must submit LIC 9182, LIC 508, and a copy of picture ID for the person to the email office at:CCLDCCPOC.RO@dss.ca.gov or Join Guardian System.

The facility was complying for a (Small Family Child Care Home) with Title 22 Regulations at the time of inspection. A license will be issued after final review, and management approval. In the event additional requirements are needed, Maria Morris will be notified.

An exit interview conducted with Maria Morris. Appeal Rights were explained. Maria Morris was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

End of report

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

LIC809 (FAS) - (06/04)

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