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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628620
Report Date: 04/18/2023
Date Signed: 04/18/2023 10:47:34 AM

Document Has Been Signed on 04/18/2023 10:47 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:CUMMINGS, DONNA FAMILY CHILD CAREFACILITY NUMBER:
376628620
ADMINISTRATOR:DONNA CUMMINGSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 303-2380
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Donna Cummings TIME COMPLETED:
11:15 AM
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On April 18th, 2023 at 09:15 AM, Licensing Program Analyst (LPA) David Miller conducted an unannounced Annual Required Inspection and met with the Licensee Donna Cummings. LPA disclosed the purpose of the inspection and was granted facility entry by the Licensee. The licensee, staff Jessica Koski and seven (7) daycare children, one child under 2-years of age, and the remainder were pre-schoolers were present in the facility during this inspection.

This facility is a two (2) story, four (4) bedroom, three (3) bathroom home. Licensee accompanied LPA during this inspection. Licensee is using the following areas for daycare: living room, family room, kitchen, bathroom 1, and daycare room. Off limits areas include: master bedroom and bathroom (upstairs) and bedrooms 2 and 3, and bathroom 2 located downstairs, and are made inaccessible via a safety gate and safety doorknobs. Applicant states she will utilize backyard for outdoor activities. 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. 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 expire in 05/22/2023. Licensee has required immunizations. Licensee completed the mandated reporter training on 04/01/2022. The facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 02/24/2023.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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: CUMMINGS, DONNA FAMILY CHILD CARE
FACILITY NUMBER: 376628620
VISIT DATE: 04/18/2023
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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.

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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
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: CUMMINGS, DONNA FAMILY CHILD CARE
FACILITY NUMBER: 376628620
VISIT DATE: 04/18/2023
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No deficiencies cited.

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 Donna Cummings. 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: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC809 (FAS) - (06/04)
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