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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406209618
Report Date: 02/17/2022
Date Signed: 02/17/2022 12:33:12 PM

Document Has Been Signed on 02/17/2022 12:33 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KELMIS FCC AKA LITTLE PRESCHOOL ON PRAIRIEFACILITY NUMBER:
406209618
ADMINISTRATOR:MARIE KELMISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 238-4288
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
02/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Marie KelmisTIME COMPLETED:
12:45 PM
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On February 17, 2022 at 10:40 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an Annual/Random inspection. Prior to entering the facility, LPA conducted Covid-19 screening questions. LPA met with Licensee Marie Kelmis and advised her the purpose of the inspection. Licensee provided LPA a tour of the facility inside and out. There were 12 children in care at the time of the inspection.

LPA observed required licensing forms posted on the wall at the entrance of the facility. The licensee is currently using the one room/classroom, one bathroom, kitchen, patio, and backyard for children in care. LPA did not observe any toxin/hazards accessible to children in care. Licensee has the disinfectants secured under the kitchen since preventing children from having access. LPA observed a 2A10BC fire extinguisher with a purchase date of 1/13/22 mounted on the wall readily accessible. Licensee advised to ensure the fire extinguisher is serviced or a new one in purchased every year. The facility has working smoke and carbon monoxide detectors. LPA observed age appropriate toys and furniture readily accessible to children in care. The backyard is enclosed by fence. LPA observed age appropriate toys and structures in the backyard readily accessible to children in care. Licensee advised there are no firearms or live ammunition in the home.

Continued on 809-C

LPA observed the facility roster identified that it was current. A sampling of children records were reviewed and found to be current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Licensee's Pediatric CPR/First-Aid certificate is current and valid until 8/10/2023. Licensee's Mandated Reporter certificate is current and valid until 3/3/2022. The last fire drill was completed on 11/17/2021. LPA discussed current Covid-19 requirements with licensee.

No deficiencies were cited during today's inspection.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KELMIS FCC AKA LITTLE PRESCHOOL ON PRAIRIE
FACILITY NUMBER: 406209618
VISIT DATE: 02/17/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

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.

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 [or facility representative] 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 [facility representative] 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.

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

Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC809 (FAS) - (06/04)
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