367700245-4-8-2022-12-CC-LTMR-CDAPJ9-20220408112110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700245
Report Date: 04/08/2022
Date Signed: 04/08/2022 11:21:21 AM

Document Has Been Signed on 04/08/2022 11:21 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:	BURRELL-BENTLEY FAMILY CHILD CARE		FACILITY NUMBER:	367700245
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	04/08/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	LaToya Burrell-Bentley		TIME COMPLETED:	11:36 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	Licensing Program Analyst (LPA) Thompson-Miller met with Applicant, LaToya Burrell-Bentley, who guided analyst on a tour of the facility for a Prelicensing Inspection. This is a two story 3 bedroom, 3 bathroom home with kitchen, dining, living room (child care), laundry room, loft and garage. There is a spa on the premises (has no water at this time), Declaration provided. Family members residing in the home include two adults (applicant, applicant daughter) and one child. Days/hours of operation are Monday through Friday 6AM to 11PM. Incidental Medical Services (IMS) policy was discussed. Physical Plant: Main care is in the living room and the activities will also be conducted in the garage. Children use the bathroom next to the kitchen. Off limit areas include the entire upstairs (all Bedrooms #1, #2, #3, bathroom #2 and #3). The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents (laundry room off limits, safety knob), cleaning compounds (kitchen cabinet under sink with a safety latch), medicines (off limits area) and hazardous items (sharp knives - in tight fitting container in the kitchen upper cabinet) that can pose a danger to children. Fireplace is screened. There are safe age appropriate toys, play equipment and materials. The Smoke Detector, Fire extinguisher (2A10BC) and Carbon Monoxide Detector are in operable condition. Stairs require a gate. Per Applicant no one smokes in the home. Electrical outlets are covered, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/play equipment to be removed from the premises. There is a designated area for ill children as necessary in living room. Per Applicant there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell). LPA explained to conduct Fire/earthquake drills every six months and document. LPA provided the Roster and explained how to complete and maintain current. Age appropriate napping equipment (to be purchased cots). No pets.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

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: BURRELL-BENTLEY FAMILY CHILD CARE	FACILITY NUMBER: 367700245
	VISIT DATE: 04/08/2022

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Bathroom: No shower or tub. Restroom free of hazards. The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils (knives - in tight fitting container), open bottles of alcohol are inaccessible. If food is brought from the children’s home it will be labelled and dated. The home has a clean and fully stocked refrigerator/freezer. No chemicals in the kitchen were observed to be accessible. Breakfast, lunch, dinner and snacks will be provided.

Outdoor: The backyard is completely fenced (brick back wall, wooden fencing). There is no large swing/slide. There is a basket ball hoop. There is a spa (gated) located on the gazebo (off limit, gated). Applicant provided a Declaration regarding the spa (has no water, will supervise during outside play). The backyard is free of lawn mower, gardening tools, poisonous plant, thorn trees. There is cushioning or resilient material (grass) and cement in the backyard.

Advisory/Other: First Aid kit to be made available. CPR/First Aid expire 01/28/2023. Mandated Reporter 10/30/2023. Electrical outlets are to inaccessible, any baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/play equipment shall be removed from the premises. The window cords are to be made accessible to children.

Review of records to be maintained: LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep and Lead Poisoning flyer's, COVID-19 posters and CDPH Mandate (masking).

LPA to provide: The following were observed/discussed and or provided: Seat Belt Safety, Safe Sleep poster, forms required for children file (LIC311D), Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Staffing and Ratio (capacity limitations handout provided), Emergency and Disaster Information (LIC610A, LIC9148), Lead Flyer Requirement, liability insurance (LIC282) must have signed form on file if no liability insurance.

Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

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: BURRELL-BENTLEY FAMILY CHILD CARE	FACILITY NUMBER: 367700245
	VISIT DATE: 04/08/2022

NARRATIVE

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The following was discussed with the 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 (www.mandatedreporterca.com) were reviewed; Applicant reminded that 100% supervision is required at all times to children in care; Applicant made aware that it is his/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. Per Applicant no on smokes in the home. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. Licensee advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov .

Applicant advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). 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.

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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

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: BURRELL-BENTLEY FAMILY CHILD CARE	FACILITY NUMBER: 367700245
	VISIT DATE: 04/08/2022

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Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Applicant shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of family child care laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

This facility plans to provide Incidental Medical Services (IMS). For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Prior to making alterations or additions to a family child care home or grounds, the Applicant 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. Applicant 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.

Applicant 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: BURRELL-BENTLEY FAMILY CHILD CARE	FACILITY NUMBER: 367700245
	VISIT DATE: 04/08/2022

NARRATIVE

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LPA discussed the safe sleep regulations with licensee name 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 LaToya Burrell-Bentley 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.

Before licensure the following must be completed:
1. Backyard spa has some locks to be secured to the spa so as to not allow any access to the inside of the spa.
2. Spa motor to be inaccessible to children while outside
3. Air Conditioner unit in accessible
4. Window cords to be inaccessible
5. Backyard wooden fence has nails to be inaccessible and replace some wooden fence planks.
6. Garage internet box to be inaccessible
7. Stairs require a gate.

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. Applicant advised that all corrections are due within 30 days or the application may be withdrawn.

A notice of site visit was given. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.
Exit interview conducted and report was reviewed with Applicant LaToya Burrell-Bentley. This report was read and provided to Applicant LaToya Burrell-Bentley on this date.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

LIC809 (FAS) - (06/04)

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