566216158-9-15-2021-17-CC-BCES-C6VR2U-20210915123856

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216158
Report Date: 09/15/2021
Date Signed: 09/15/2021 12:39:07 PM

Document Has Been Signed on 09/15/2021 12:39 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:	HORSTING FCC AKA FLOURISH WITHIN		FACILITY NUMBER:	566216158
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/15/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Lara Horsting		TIME COMPLETED:	12:45 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 September 15, 2021 at 10:30AM, Licensing Program Analyst (LPA) Betzayra Cervantes conducted an announced visit for the purpose of performing a pre-licensing inspection. Prior to entering the facility, LPA spoke to applicant Lara Horsting and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Applicant and LPA toured the facility inside and outside. There were no children in care at the time of the inspection. One fingerprint cleared adult was present during the inspection.

The home is a two bedroom, one bath single family duplex. The applicant will use the living room, kitchen, one bathroom, front porch, backyard, and converted garage which is used as the main playroom and has a separate entrance for the day-care. The 2 bedrooms are off limits and the rooms are secured with a latch making them inaccessible to children in care. There are age appropriate toys and furnishings in good condition and free of hazards. Applicant will be using the front porch as part of her daycare. LPA observed one locked storage shed and a locked cabinet which is affixed to the fencing located in the backyard. LPA did not observe any toxins/hazardous items accessible to children. The back yard has a full size trampoline with a child safety net around it. Applicant was advised to stay within the manufacturers requirements for the trampoline. LPA also observed a wooden fort and playhouse. LPA advised applicant that she must provide visual supervision at all times while the children are playing outside in the backyard and on the trampoline.

LPA observed a 2A10BC fire extinguisher mounted inside a cabinet in the kitchen with a purchase date of 07/29/21. LPA had applicant test smoke detector in the home and it was found operational. Applicant does not have a carbon monoxide detector in the home. Applicant stated that she would be purchasing and installing one today. Detergents and cleaning compounds are stored out of reach of children. The bathroom to be used for children in care was observed to be clean and sanitary.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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 3

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: HORSTING FCC AKA FLOURISH WITHIN	FACILITY NUMBER: 566216158
	VISIT DATE: 09/15/2021

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 the home to be orderly. No bodies of water were observed on site. Applicant stated that there are no guns or ammunition in the home. Detergents and cleaning compounds are stored out of reach of children. Applicant states the home currently has liability insurance.

Applicant's Pediatric First Aid/CPR certificate is valid until 07/30/2023. AB 1207 Mandated Reporter Training is valid until 07/25/2023. Applicant does not currently have documentation regarding control of property. LPA advised that documentation is required prior to licensure. Preventative Health and Safety and Nutrition Training completed on 08/25/2021.

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.html

LPA issued the applicant updated samples of state required forms to be kept in the children's records. LPA also discussed and provided Guidelines to Safe Sleep and Effects of Lead Exposure leaflets. Applicant was provided PIN 20-24-CCP - Recently Approved Safe Sleep Regulations In Effect and LIC 9227 (Infant Sleeping Plan). Applicant was informed that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. Applicant was made aware of the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPA reviewed COVID-19 guidelines/resources with applicant (RAST Technical Assistance Visit completed). LPA also reminded applicant to continue monitoring the CCLD website for COVID-19 updates and guidance.

CONT ON LIC 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: HORSTING FCC AKA FLOURISH WITHIN	FACILITY NUMBER: 566216158
	VISIT DATE: 09/15/2021

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

Based on the LPA’s observation, the following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 09/29/2021.

1. Applicant will submit proof of an operational carbon monoxide detector.
2. Control of Property

Licensure is pending following receipt of corrections. Once licensed, the applicant is required to comply with the terms and limitations stated on the license. Exit interview was conducted with Lara Horsting. A copy of this report was reviewed and provided to the applicant.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3