<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566200767
Report Date: 06/05/2024
Date Signed: 06/05/2024 01:02:33 PM

Document Has Been Signed on 06/05/2024 01:02 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:CUMMINS FAMILY DAY CARE HOMEFACILITY NUMBER:
566200767
ADMINISTRATOR/
DIRECTOR:		CUMMINS, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 494-0784
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 9DATE:
06/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:36 AM
MET WITH:Lisa CumminsTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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 6/5/0224, at 10:36 AM, Licensing Program Analyst (LPA) Martina Jimenz conducted a Random/Annual Inspection of the Cummins Family Child Care Home (FCCH). LPA met with Lisa Cummins, Licensee and Darrel Cummins, assistant. LPA explained the purpose of the inspection and together LPA and licensee toured the inside & outside of the home. The areas the child care services area provided are the living room, dining room, bedroom #1 (activity room), bedroom #3(napping room), day-care room that includes the children's bathroom and the completely fenced backyard.

The off limit areas consists of bedrooms #2, and bedroom# 4 as well as two bathrooms. At the time of the inspection LPA observed nine children in care along with an Assistant (spouse, cleared and associated) providing care and supervision.

LPA observed the FCCH to be orderly. The bathroom which is used for care is clean and free of toxins. LPA observed cleaning compounds in a secured cabinet in the garage. Additionally, LPA observed medications in the FCCH stored on a secured elevated shelf in hallway cabinet which is also inaccessible to children in care. Sharps in the home are in an elevated location in the kitchen. Toys, furniture and equipment in the FCCH are age appropriate.
(CONTINUES ON LIC809C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: CUMMINS FAMILY DAY CARE HOME
FACILITY NUMBER: 566200767
VISIT DATE: 06/05/2024
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
26
27
28
29
30
31
32
LPA observed required licensing forms and documents post in the day-care room. LPA observed a combination smoke/carbon monoxide detector in the FCCH which were tested 10:20 AM and found to be operable. LPA observed a regulation fire extinguisher in the FCCH's day-care room area which was serviced on 05/30/2024. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually.

The FCCH's backyard is enclosed by a combination of wrought iron, and brick fencing. The fence’s entry/exit gates are secure. The area is partitioned by fencing, separating the child care area from the area used for personal use. LPA observed age appropriate toys, games and play equipment in backyard area. LPA reminded Licensee to replace toys and equipment when such begins to degrade or are not in good repair. LPA observed no bodies of water on the premises. LPA the licensee children must be supervised at all time while in the children's out door play area.

LPA reviewed children's records. All records reviewed are current and complete, with children's emergency contact information as well as immunization records, among other required documentation. The Licensee's records are current and complete with Pediatric CPR and First Aid certifications expiring on 5/13/2025 (EMSA approved) and Mandated Reporter training expiring on 4/13/2026. LPA observed four small dogs are on site. LPA reviewed the vaccination record for the dogs which is current. LPA observed the last fire drill at the FCCH and documented occurred on 05/3020/24. LPA observed a secured firearms with the ammunition secured and stored separately on site at 10:11 A.M.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN
(CONTINUES ON LIC 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CUMMINS FAMILY DAY CARE HOME
FACILITY NUMBER: 566200767
VISIT DATE: 06/05/2024
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
26
27
28
29
30
31
32
A.M22-02CCP. 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) or (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 discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

Licensee 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
CONTINUES ON LIC809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: CUMMINS FAMILY DAY CARE HOME
FACILITY NUMBER: 566200767
VISIT DATE: 06/05/2024
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
26
27
28
29
30
31
32
During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 06/05/2024.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The licensee has a signed Property Owner/Landlord Consent form (LIC 9149) post and on file. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Lisa Cummins.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4