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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628688
Report Date: 09/16/2021
Date Signed: 09/16/2021 01:07:01 PM

Document Has Been Signed on 09/16/2021 01:07 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:GLENN, MYRA FAMILY CHILD CAREFACILITY NUMBER:
376628688
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
09/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Myra GlennTIME COMPLETED:
01:15 PM
NARRATIVE
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On 09/16/2021 at 10:30 AM, Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Annual Required Inspection and met with the Licensee, Myra Glenn. LPA disclosed the purpose of the inspection, was granted entry into the facility by the Licensee, and proceeded to tour the facility. At time of inspection Licensee's 2 grandchildren were in care (ages 4 and 6). This facility is a single-story, 3 bedroom, 2 bath house. Licensee accompanied LPA inside and out of the facility during this inspection. Licensee will use the following areas for child care: living room, dining room, kitchen, one bedroom and hall bathroom. Off limits areas include: 2 bedrooms, laundry room, and one bathroom. These areas were not made inaccessible to children at the time of the inspection. Licensee stated she is not currently utilizing the backyard and will use the nearby park for outdoor activities. Licensee stated she understands total supervision is required during outdoor play. Backyard is made off limits via door lock. There are no bodies of water observed during time of visit.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. Hazardous item (Cleaning supplies) were accessible to children in the kitchen and bathroom. The licensee has toys, play equipment and materials available. 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/CPR expired 08/2020 and Licensee is requesting a waiver for renewal due to COVID 19 pandemic. Licensee completed Mandated Reporter Training on 08/2020. Facility roster, and Fire and Disaster Drill log were not available.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
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: GLENN, MYRA FAMILY CHILD CARE
FACILITY NUMBER: 376628688
VISIT DATE: 09/16/2021
NARRATIVE
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LPA provided and discussed 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. Licensee was also provided handouts with information regarding Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

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.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D(s).

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/16/2021 01:07 PM - It Cannot Be Edited


Created By: Dana Stevens On 09/16/2021 at 11:58 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: GLENN, MYRA FAMILY CHILD CARE
FACILITY NUMBER: 376628688

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2021
Section Cited
CCR
102417(g)(4)

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102417 Operation Of A Family Child Care Home (g)(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger... shall be stored where they are inaccessible to children.The requirement was not met as evidenced by:
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Licensee will remove cleaning products from unlatched cupboards and place then in high cupboards, out of reach of children. Licensee will provide a photo of correction via email to Analyst by end of day 09/18/2021.
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Based on analyst observation, licensee had cleaning supplies accessible in the unlatched cabinet below the bathroom sink and kitchen sink. Though licensee had children under her direct supervision at all times during the visit, having an unlatched cabinet with accesible cleaning products is a potential risk to children in care.
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Type B
10/15/2021
Section Cited
CCR102416.3(a)(6)

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102416.3 (a)(6) Alterations to Existing Buildings or Grounds. Prior to making alterations...to a family child care home...the licensee shall notify the Department...including...any change from an area of the..home previously identified as "off limits"...This requirement was not met as evidenced by,
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Licensee will install door knob covers or safety latches to make off-limit areas inaccessible to children in care and provide a photo of correction to analyst by 10/15//2021
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Based on Analyst observation Off Limit areas were not made inaccessible which poses a potential health and safety risk to children in care.
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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:Cynthia Gray
LICENSING EVALUATOR NAME:Dana Stevens
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/16/2021 01:07 PM - It Cannot Be Edited


Created By: Dana Stevens On 09/16/2021 at 12:22 PM
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: GLENN, MYRA FAMILY CHILD CARE
FACILITY NUMBER: 376628688

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/15/2021
Section Cited
CCR
102417(g)(9)(A)(1)

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102417(g)(9)(A)(1) Operation of a Family Child Care Home All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill...
This requirement was not met as evidenced by,
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Licensee will provide a current and updated Fire and Disater Drill log to analyst via email by 10/15/2021.
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Based on LPA observation and record review, Licensee did not have a Fire and Disaster Drill log which poses a potential health and safety risk to children in care.
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Type B
10/15/2021
Section Cited
CCR102417(g)(8)

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102417(g)(8) Operation of a Family Child Care Home The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:Each family child care home shall have a current roster of children...
this requirement was not met as evidenced by,
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Licensee will provide a copy of complete and current roster to analyst via email by 10/15/2021.
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Based on LPA observation and record review, Licensee did not have a current roster of the children, which poses a potential health and safety risk to children in care.
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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:Cynthia Gray
LICENSING EVALUATOR NAME:Dana Stevens
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2021


LIC809 (FAS) - (06/04)
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