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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376606205
Report Date: 06/26/2023
Date Signed: 06/26/2023 11:52:56 AM

Document Has Been Signed on 06/26/2023 11:52 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HILLIARD, MICHELLE FAMILY CHILD CAREFACILITY NUMBER:
376606205
ADMINISTRATOR:HILLIARD, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 729-5263
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 3DATE:
06/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michelle HilliardTIME COMPLETED:
12:15 PM
NARRATIVE
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On June 26, 2023 at 10:30 AM, Licensing Program Analyst (LPA) David Miller conducted an unannounced Annual 1-year Inspection and met with the licensee Michelle Hillaird. LPA disclosed the purpose of the inspection and was granted facility entry by the Licensee. The licensee and three children (two infants and one preschooler) were present in the facility during this inspection. This facility is a three (3) bedroom, two (2) bathroom two (2) story home. Licensee accompanied LPA during this inspection. Licensee is using the following areas for daycare: family room, kitchen and hallway bathroom 1. Off-limits areas include the garage, bedroom 1 (downstairs), and all bedrooms upstairs, Bedroom 2 and bedroom 3, and are made inaccessible via safety gates and safety locks. Business Hours: Monday-Friday 6:00 a.m.-6:30 p.m. Licensee was reminded that she may not make any changes to approved daycare areas before consulting with the licensing office.

The fire extinguisher and smoke/carbon monoxide detector met requirements. Hazardous items were observed inaccessible to children during this inspection. The licensee has available toys, play equipment and materials. Children play outside in the fenced backyard. Licensee was reminded that continuous supervision is to be given to children whenever engaged in outdoor activities. No bodies of water were observed on the premises during the inspection. Licensee stated there are no weapons in the home and LPA did not observe any firearms at the time of this inspection. Licensee’s First Aid and CPR certifications expired on 06/19/2023. Licensee has required immunizations. Licensee completed the mandated reporter training on 06/16/2022. The facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 05/21/2022.

Licensee 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: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HILLIARD, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376606205
VISIT DATE: 06/26/2023
NARRATIVE
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LPA discussed the safe sleep regulations with licensee 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 licensee 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.

LPA reminded Licensee of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare.

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.

A deficiency was observed as per California Code of Regulations, (Title 22, Division 12 & Chapter 3), and is being cited on the attached LIC 809-D. A copy of the report and appeal rights (LIC 9058) was provided to the applicant and notice of site visit (LIC9213) was given to Licensee and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee Michelle Hilliard. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/26/2023 11:52 AM - It Cannot Be Edited


Created By: David Miller On 06/26/2023 at 10:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HILLIARD, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376606205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the CPR/First Aid card expired on 06/19/2023; which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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The licensee stated that she will complete the CPR/First Aid training and submit proof of completion of this course to the agency by 07/28/2023
Type B
Section Cited
CCR
102417(g)(9)(a)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview) and record review, the licensee did not comply with the section cited above as the last emergency drill was conducted in May of 2022; ] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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The licensee stated that she will complete an emergecy drill and submit an emergency drill log to the agency by 07/28/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tulam Vu
LICENSING EVALUATOR NAME:David Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/26/2023 11:52 AM - It Cannot Be Edited


Created By: David Miller On 06/26/2023 at 10:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HILLIARD, MICHELLE FAMILY CHILD CARE
FACILITY NUMBER: 376606205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as the licensee did not have a Safe Sleep log; which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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The licensee stated that she will monitor and document all symptoms when infants are sleeping, and submit the Safe Sleep log documentation log to the agency by 07/28/2023 to verify that she is complying with this regulation.
Section Cited
Infant Safe Sleep
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tulam Vu
LICENSING EVALUATOR NAME:David Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2023


LIC809 (FAS) - (06/04)
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