367700204-5-19-2021-12-CC-LTMR-C373BZ-20210519180709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700204
Report Date: 05/19/2021
Date Signed: 05/19/2021 06:07:44 PM

Document Has Been Signed on 05/19/2021 06:07 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:	COOPER FAMILY CHILD CARE		FACILITY NUMBER:	367700204
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/19/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Latonya Cooper		TIME COMPLETED:	04:58 PM

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Licensing Program Analyst (LPA) Thompson-Miller conducted a Tele-Visit with Licensee/Applicant Latonya Cooper (Ms. Cooper is currently licensed with Monterey Park office, small family child care home, to be closed) who guided analyst on a tour of the facility for a Prelicensing Inspection Tele Visit (virtual). This is a two story 5 bedroom, 3 bathroom home with kitchen, dining, living room, family room, laundry room, loft and garage. There is no pool/or body of water on the premises. Family members residing in the home include one adult (Licensee/Applicant) and two children. Days/hours of operation will be Monday through Friday from 6AM to 5AM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Home is clean and orderly, fireplace is screened, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, 2A10BC Fire Extinguisher, 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 entire upstairs (all Bedrooms #1- #5, Bathroom #1 and #2, loft), laundry room (safety latch to be secured) and garage. There is a working telephone (cell and landline), poisons and cleaning items inaccessible (in laundry room) to children. Stairs have a gate.

Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Sharp items (knives), medication (upstairs) and chemicals (laundry room) are inaccessible. Toilets and faucets are clean and operable and home has a clean fully stocked of food refrigerator/freezer.

Outdoor: Backyard off limits at this time until construction of swing set is complete (estimated time to complete two to three weeks). Ms. Cooper to notify CCL/LPA when ready to allow children to play in the backyard. There is one small dog (will not be around children in care).

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

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: COOPER FAMILY CHILD CARE	FACILITY NUMBER: 367700204
	VISIT DATE: 05/19/2021

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Advisory/Other: First Aid kit readily available. CPR/First Aid expire 10/01/2021. The electrical outlets are covered. Children nap on cots, window in the home have cordless blinds. Licensee/Applicant reminded to supervise children at all times.

Names of all adults living in the home: 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: Seat Belt Safety, Safe Sleep, Notification of Parents' Rights.

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/Applicant:

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/Applicant reminded that 100% supervision is required at all times to children in care; Licensee/Applicant 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/Applicant 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

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: COOPER FAMILY CHILD CARE	FACILITY NUMBER: 367700204
	VISIT DATE: 05/19/2021

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Licensee/Applicant 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.

LPA will mail CCL and COVID-19 required posters.

Before licensure the following must be completed:

1. Photo of laundry room inaccessible
2. Required posting (CCL and COVID-19)
Once corrections have been verified, the application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Licensee/Applicant advised that all corrections are due within 30 days or the application may be withdrawn.
Exit interview conducted and a copy of this report will be emailed to Licensee/Applicant Latonya Cooper (due to COVID-19). The read receipt is in lieu of a signature.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021

LIC809 (FAS) - (06/04)

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