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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619195
Report Date: 10/24/2024
Date Signed: 10/24/2024 11:58:51 AM

Document Has Been Signed on 10/24/2024 11:58 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:NICKELL, LISA FAMILY CHILD CAREFACILITY NUMBER:
376619195
ADMINISTRATOR/
DIRECTOR:		LISA NICKELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 316-0603
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
10/24/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Lisa NickellTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 10/24/2024 Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Annual Random Inspection. Upon arrival, LPA was greeted by Licensee Lisa Nickell. LPA disclosed the purpose of the inspection and was granted entry into the facility. There were 3 daycare children present at the time of the inspection.

Licensee stated she currently has four children enrolled. Licensee accompanied LPA throughout the inspection of this 3 bedroom, 2 bathroom home. The following areas are used for child care: living room, dining room, kitchen, bedroom #1 and hall bathroom. Off Limit areas include: Bedroom 2, master bedroom, master bath, and the garage. These areas are made inaccessible with safety gates. The Licensee is utilizing the backyard for outdoor activities of children and Licensee stated total supervision is provided.The home has bodies of water in the backyard; a Jacuzzi with a locking cover and a water fountain that is also covered.

The fire extinguisher and combination smoke/carbon dioxide detector met requirements.  The licensee has toys, play equipment and materials available. A review of records on this date indicates that all individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee's First Aid and CPR certifications are current and expire 03/2026. Licensee renewed Mandated Reporter Training 07/02/2024. Facility roster and a sample of children's files were reviewed and found complete. The last fire drill was conducted and documented in 08/2024.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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: NICKELL, LISA FAMILY CHILD CARE
FACILITY NUMBER: 376619195
VISIT DATE: 10/24/2024
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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.


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 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and copy of report and appeal rights were provided to the licensee and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC809 (FAS) - (06/04)
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