<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628302
Report Date: 06/17/2021
Date Signed: 06/17/2021 11:16:31 AM

Document Has Been Signed on 06/17/2021 11:16 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:BLACKBURN, LESLE FAMILY CHILD CAREFACILITY NUMBER:
376628302
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee Lesle BlackburnTIME COMPLETED:
11:20 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
On 6/17/21 at 10:30 a.m. Licensing Program Analyst, Joelle Redding, made an unannounced visit for the purpose of an Annual inspection. During this visit, there were 6 children in care. The facility is within ratio and capacity. Licensee has a part day program from 8:30 a.m. to 1:30 p.m. with the month of July off.

LPA toured the home. Primary child care areas are first floor bedroom (childcare room) and bathroom, kitchen and fully fenced backyard. Off limits areas have been made inaccessible with the use of a safety gate. There are no weapons stored in the home or on the property and there are no bodies of water present. The fireplace has been secured and the stairs have been made inaccessible. The fire extinguisher is full and of adequate size and mounted on the wall of the childcare room.. The smoke alarm and carbon monoxide detector (mounted above the doorway in the childcare room) are operational. The home is clean, orderly and has adequate ventilation and heating. Licensee has provided sufficient space for the children to eat, sleep and play within the home. Children’s toys and play equipment are safe and age appropriate. There is a working telephone and all required forms are posted. Outdoor play space is fully fenced and supervision is provided at all times. No hazards were noted. Children’s files were reviewed for emergency information. Licensee's pediatric CPR/FA certificate with Heartsaver is valid through 7/2021. Provider is scheduled for a renewal class next month. SB 792 (Staff Immunizations - Measles, Pertussis, Influenza) and current TB tests requirements have been met. AB 1207, Mandated Reporter Training certificate on file.

Licensee is to be present in the home to ensure children are supervised and reminded that no children are to be left in parked vehicles and car seats are not to use used for sleeping. Children will be observed upon entry and throughout the day for signs of illness an an appropriate isolation area is established for sick children. Capacity limitations were reviewed.

Licensee doesn't have any children under 3 years old, however, Safe Sleep was discussed to include
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: BLACKBURN, LESLE FAMILY CHILD CARE
FACILITY NUMBER: 376628302
VISIT DATE: 06/17/2021
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
26
27
28
29
30
31
32
requirements for cribs/play yards, proper infant placement, supervision and documentation while sleeping. An Individual Sleeping Plan (LIC 9227) and safe sleep log along with Child Care Providers Guide to Safe Sleep Handout was provided. LPA discussed California Megan's Law and the website was provided as follows: www.meganslaw.ca.gov. Licensee is reminded that infants may not be swaddled while in care and walkers, exersaucers, jumpers, bouncy seats, napping portables and drop sided cribs are not permitted for use.

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, an updated Plan of Operation that includes 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. There are no services in place.

Licensee is signed up to receive Quarterly updates and Provider Information Notices (PIN) via email.

No deficiencies are cited.

Notice of Site Visit was posted during this visit and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2