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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376617364
Report Date: 11/30/2021
Date Signed: 11/30/2021 05:48:19 PM

Document Has Been Signed on 11/30/2021 05:48 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BROWN, LISA FAMILY CHILD CAREFACILITY NUMBER:
376617364
ADMINISTRATOR:LISA BROWNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 972-3724
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
11/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lisa BrownTIME COMPLETED:
06:00 PM
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On 11/30/2021, at 03:00 PM, Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Annual Required Inspection and met with the Licensee, Lisa Brown.  LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. 14 children ages (5 years - 12 years) and Licensee's assistant, were present in the facility during this inspection.  This facility is a two story, 6 bedroom, 4 bath home. Licensee accompanied LPA inside and outside of the facility during this inspection. The following areas are used for child care are: Living room, kitchen, dining room, downstairs day care rooms, and downstairs day care bathroom. Off-limits areas are the entire upstairs. Licensee provides care for only school-age children at this time, but understands that a safety gate must be in place at the bottom of stairs when children under 5 are present. The backyard is used for outdoor activities and is fully fenced.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements.  All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.  Licensee's First Aid and CPR certifications expire 09/2022 and assistant's First Aid and CPR certification expires on 07/2023. The Last Fire/Earthquake drill was conducted on 11/2021. Licensee and Assistant have required immunization.  Licensee completed Mandated Reporter Training in 11/2021 and assistant completed Mandated Reporter training 10/2021. Facility roster was reviewed and found complete. Licensee does not provide care for infants.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2021
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: BROWN, LISA FAMILY CHILD CARE
FACILITY NUMBER: 376617364
VISIT DATE: 11/30/2021
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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.

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

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/inspection-process.

Exit interview conducted and report was reviewed with the licensee.

No deficiencies cited.


A copy of this report, appeal rights and Notice of Site Visit were provided to Licensee. Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
LIC809 (FAS) - (06/04)
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