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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700246
Report Date: 11/29/2021
Date Signed: 11/29/2021 03:22:22 PM

Document Has Been Signed on 11/29/2021 03:22 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:JAMES FAMILY CHILD CAREFACILITY NUMBER:
367700246
ADMINISTRATOR:RACHEL JAMESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(442) 202-7857
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:29 PM
MET WITH:Rachel JamesTIME COMPLETED:
03:37 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
Licensing Program Analyst (LPA) Thompson-Miller met with Licensee Rachel James who guided analyst on a tour of the facility for a Case Management - Prelicensing Change of Location Inspection. This is a two story 5 bedroom, 3 bathroom home with kitchen/dining, living room, dining room, laundry room, family room and garage. There is no pool or body of water on the premises. Family members residing in the home include three adults (Licensee, Licensee spouse, Licensee adult daughter) and five children. All adult's are fingerprint cleared and associated. Days/Hours of operation Sunday through Friday, 3AM to 1:30AM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Home currently is under construction due to flooding in downstairs bathroom. There are contractor plastic tarp at the entrance to the kitchen and in the hallway entrance to the right leading to the garage. The entire downstairs is under construction except for the living and dining rooms at entrance. Photos taken of the construction areas of the home.



Main care is provided in the living and dining rooms at entrance on the left. Children use the bathroom next to the kitchen (currently under construction). Off limit areas include the entire upstairs (4 Bedrooms, 2 bathroom) and laundry. The garage is off limits. Licensee reminded to conduct Fire/earthquake drills every 6 months and document. Roster provided and explained to complete and maintained current. There is a designated area for ill children as necessary in the living room. There are age appropriate toys and play equipment. The smoke detector and carbon monoxide detector are in operable condition. LPA observed the required fire extinguisher (2A10BC) is fully charged. Per Licensee, there are no weapon/firearms in the home. The facility sketch will be updated and submitted to LPA. There is a working telephone (cell).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2021
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 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JAMES FAMILY CHILD CARE
FACILITY NUMBER: 367700246
VISIT DATE: 11/29/2021
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
Kitchen/bathroom: LPA unable to inspect due to the construction. Breakfast, lunch, dinner and snacks will be provided.

Outdoor: The backyard (cement) is completely fenced (hard plastic). There are age appropriate toys and a covered patio area. The play area is clear and clean of debris, play area is fenced and gated all around. There are roses and a cactus plant accessible to children in the back yard. Air conditioner located on patio area. One small dog (upstairs, caged or outside). Right side has a gate and the left side has a fence.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 07/12/23. Preventative Health & Safety completed 11/7/2021. Mandated Reporter expire 07/16/2023. Living room (child care) electrical outlet are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. No Window cords throughout the home are inaccessible or observed.

Documents Provided and or Discussed: The following were observed to be in regulation of Title 22 requirements: Fire Drill Log , Roster, Postings were observed, Safe Sleep and Lead Poisoning flyer's provided. Licensee stated currently does not have child care insurance.

Names of all adults living in the home: All adults living/residing in the home are fingerprint cleared and associated.


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.htm
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JAMES FAMILY CHILD CARE
FACILITY NUMBER: 367700246
VISIT DATE: 11/29/2021
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
The following was discussed with the Licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed; Licensee reminded that 100% supervision is required at all times to children in care; Licensee made aware that it is her/their responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

Licensee advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "child care" room; Room additions to the family child care home. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JAMES FAMILY CHILD CARE
FACILITY NUMBER: 367700246
VISIT DATE: 11/29/2021
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
Documents Provided and or Discussed: Lead Flyer, Safe Sleep, Seat Belt Safety.

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 Rachel James 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.


Before licensure the following must be completed:
1. Air conditioner unit to be inaccessible
2. Contractor/construction plastic tarp to be secured
3. Child care bathroom (downstairs) in not usable
4. Backyard has roses and a cactus plant accessible

Once corrections have been verified, the application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Licensee ant advised that all corrections are due within 30 days or the application may be withdrawn.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Rachel James. This report was read and provided to Licensee Rachel James on this date.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4