376629463-12-12-2022-20-CC-JARL-CM2QKW-20221212111458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629463
Report Date: 12/12/2022
Date Signed: 12/12/2022 11:15:08 AM

Document Has Been Signed on 12/12/2022 11:15 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:	DALEY, KODY FAMILY CHILD CARE		FACILITY NUMBER:	376629463
ADMINISTRATOR:	KODY DALEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 277-7835
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	12/12/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Kody Daley		TIME COMPLETED:	10:00 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 December 12th, 2022, at 8:15 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a pre-licensing inspection with Applicant Kody Daley. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present in the home was the Applicant, Shandy Edwards (who is background cleared and associated to the pending license) and a visiting 7 month old infant. This four (4) bedroom, three (3) bathroom house was toured and inspected. This house has one (1) floor. The Applicant shall submit an updated application to the Licensing Department should the daycare operational schedule change. The Applicant understands that they will need to notify the Department of any changes to the childcare areas and obtain departmental approval before use of any new childcare areas not previously licensed. Applicant will use the following areas for childcare: the family room, one (1) bathroom and the fenced front side yard. The off limits areas include the backyard, kitchen, remaining bathrooms and the bedrooms. The bedrooms and remaining bathrooms are made inaccessible by use of child safety doorknobs. Kitchen cabinets have cabinet locks. Children will only use the living room to pass towards the fenced front side yard for outdoor activities. Two wooden fences bar children’s access into the backyard. The childcare bathroom has a door which leads to the backyard, however there is a safety door gate which makes access into the bathroom through the childcare bathroom door inaccessible. The in ground pool is located in the backyard. There is no immediate access into the pool area/backyard because the backyard is made inaccessible to children by wooden fences. The access into the backyard from the childcare bathroom is made inaccessible by use of a door safety gate. Applicant declared that children shall not utilize this pool or backyard area. Applicant states they will ensure children are kept away from both the backyard and pool areas. The fire extinguisher is rated 2A 10B: C and is located in the family room. The smoke and carbon monoxide detectors meets requirements and are operational. Poisons, detergents, cleaning compounds and medications are stored inaccessible to children. Children’s toys and play equipment are available. The Applicant has a working telephone/cell phone. The Applicant shall notify licensing should their

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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: DALEY, KODY FAMILY CHILD CARE	FACILITY NUMBER: 376629463
	VISIT DATE: 12/12/2022

NARRATIVE

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telephone number or email address ever change. The Applicant indicated there are no firearms or other weapons in the home . The Applicant intends to conduct outdoor activities in the fenced front side yard. The Applicant acknowledges continuous, visual supervision shall be given whenever children are engaged in outdoor activities. Applicant states children shall not utilize the pool. Applicant states they will ensure children are kept away from both the pool and its backyard.

The Applicant intends to occasionally transport the children in their own vehicle. The Applicant shall transport children in rear seats in appropriate child passenger restraint systems which meet applicable federal motor vehicle safety standards. The Applicant acknowledges that car seats shall only be used for transportation purposes and shall not be used for sleeping. The Applicant acknowledges children shall never be left unattended in the daycare vehicle. The Applicant further confirms maintenance of the daycare vehicle shall be upheld to ensure safety.

The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 10/13/2022 for fourteen (14) children. Landlord Consent is on file. The Applicant has provided substantiation that the Applicant has at least one year of experience as a regulated small family childcare home operator; or one year of experience as an administrator or director of as a teacher at, a licensed childcare center.

Applicant maintains documentation of proof of control of property for review by the Department. Applicant has completed the preventative health and lead poisoning prevention courses. The Mandated Reporter training was completed on 09/13/2022. The Applicant acknowledges that the Mandated Reporter training must be taken once every two (2) years. Pediatric CPR and First Aid certifications expire in June 2024. The Applicant acknowledges that pediatric CPR and First Aide certifications must be renewed prior to their expiration dates. The Applicant and adult residents in the home have criminal record clearances and/or exemptions on file. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and comply.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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: DALEY, KODY FAMILY CHILD CARE	FACILITY NUMBER: 376629463
	VISIT DATE: 12/12/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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

LPA reviewed with Applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. LPA and Applicant discussed the facility disaster plan and safety of children and pets. Applicant has three (3) dogs.

The Applicant was also informed the following items are prohibited during day care operating hours: walkers, exersaucers, jumpers, inclined sleepers and bouncy seats. Corporal punishment and smoking are not allowed in the day care.

The Applicant was provided with the Ratio/Capacity Worksheet for a large family childcare home. Applicant and LPA reviewed the Ratio/Capacity Worksheet for a large family childcare home. The Applicant recognizes that the total amount of children simultaneously in the home also includes children who reside in the home. The Applicant acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Applicant shall comply with the capacity requirements for a Small Family Child Care Home.

The Applicant states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes.

Applicant was advised that an agent of the Licensing Department upon presentation of proper identification, may enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice. The Applicant shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations. Applicant was advised that the Department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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: DALEY, KODY FAMILY CHILD CARE	FACILITY NUMBER: 376629463
	VISIT DATE: 12/12/2022

NARRATIVE

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citation, if the Applicant refuses any agent of the licensing Department entry into the daycare or any part of the daycare home.

LPA informed Applicant that the failure of a Licensee to pay all applicable and accrued fees and/or civil penalties shall constitute grounds of forfeiture of the daycare license.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. Applicant’s email address is already enrolled in the Department’s email notification system.

Additional information about the pool issue is needed, but the Applicant attests children shall not use any portion of the pool area or the fenced backyard where the pool is located. A provisional large license is issued effective today 12/12/2022. The Applicant states they will come to the licensing office to retrieve the new license when available. Exit interview conducted and report was reviewed with the Applicant Kody Daley.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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