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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215995
Report Date: 08/19/2021
Date Signed: 08/19/2021 10:36:24 AM

Document Has Been Signed on 08/19/2021 10:36 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MCCLELLAN FCC AKA WHITE HOUSE DAY CAREFACILITY NUMBER:
406215995
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:LaJoaune McClellanTIME COMPLETED:
10:40 AM
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On 8/19/2021 at 9am, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 with Licensee, LaJoaune McClellan. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee wore a face covering. LPA observed facility license and facility sketch posted inside of the home on the wall adjacent to the front door. There were no children present at time of inspection. Licensee reported that children usually arrive at 6:30am, but today is the first day of elementary school and the children's parents informed her that they would not bring children today. Licensee stated that children over the age of 2 years are encouraged to wear face coverings while indoors.

Child care services are provided in the living room, dining area and first bedroom. LPA observed age appropriate toys and furnishings in the first bedroom. The open plan kitchen is accessible to children. Detergents, cleaning compounds, medications and other items such as kitchen knives which could pose a danger to children are stored inaccessible to children. The bathroom used by children was observed to be clean and free of toxins. There are two additional bedrooms and ensuite bathroom which are made inaccessible by door knob locks. The garage door, located in the kitchen, also has a door knob lock preventing access to the garage. Licensee stated there are no guns or ammunition in the home.

Smoke and Carbon monoxide detectors were tested at 9:12am and found to be operational. The Kidde smoke/carbon monoxide detector was taken down and it was determined that model number KNCOSM-1BA was not included in the May 2021 CPSC recall of Kidde TruSense detectors. LPA observed the 2 A10 BC fire extinguisher in the kitchen with a service tag which was not date stamped. Licensee called the service company and will take the extinguisher in today to have it checked and date stamped. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee completes and documents emergency drills. The most recent drill was held on 5/14/21 at 1:30pm.
Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MCCLELLAN FCC AKA WHITE HOUSE DAY CARE
FACILITY NUMBER: 406215995
VISIT DATE: 08/19/2021
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LPA observed backyard outdoor play area to be safe and completely fenced. Licensee stated that children do not play outdoors at this time. There are no bodies of water. No hazardous items that can pose a danger to children were observed indoors or outdoors.

Licensee has current Pediatric CPR and first aid expiring on 1/23/2022. Licensee has met SB 792 immunization requirement and completed Mandated Reporter Training per AB 1207 on 8/11/2020. Licensee was reminded to renew the AB1207 certification every two (2) years. Facility roster and a sample of children's records were reviewed and found complete.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that there are no children enrolled who require medications at this time. 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: www.ada.gov/childqanda.htm

Infant Safe Sleep Regulation section 102425 was discussed. LPA provided PIN 20-24-CCP, Individual Infant Sleep Plan (LIC9227) and a sample Infant Sleep Log for 15 minute checks of all children under the age of two (2) years. LPA provided a copy of the “Effects of Lead Exposure” brochure to be distributed to all families at time of enrollment. LPA observed Licensee post the Notification of Parents Rights poster and the Emergency Disaster Plan (LIC610A) on the wall near the front door next to facility license.

LPA advised Licensee that Title 22, Division 12 regulations for Family Child Care Homes and California Department of Public Health COVID-19 guidelines for child care programs can be accessed on-line at www.cdss.ca.gov. Licensee stated that she is subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email. COVID19 Information for San Luis Obispo County can be found at https://www.emergencyslo.org/en/covid19.aspx.
In the areas evaluated today, no deficiencies were cited.

A copy of this report and appeal rights were discussed and left with Licensee, LaJoaune McClellan, whose signature on this form confirm receipt of these documents. LPA provided a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
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