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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629557
Report Date: 05/08/2023
Date Signed: 05/08/2023 09:06:13 AM

Document Has Been Signed on 05/08/2023 09:06 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ADEN, LUCKY FAMILY CHILD CAREFACILITY NUMBER:
376629557
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
05/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Lucky AdenTIME COMPLETED:
08:30 AM
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On May 8th, 2023 at 7:30 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced capacity increase inspection with Licensee Lucky Aden. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Licensee granted LPA facility entry. Present in the home was the Applicant and one child that resides in the home.

On 02/17/2023, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 04/24/2023 for fourteen (14) children. Landlord Consent is on file.

This three (3) bedroom, two (2) bathroom single family dwelling was toured and inspected. The following areas for childcare are: the living room, dining room, one (1) bedroom, one (1) bathroom and the fenced backyard. The off limits areas include the kitchen, remaining bedrooms, and bathroom. Access into the kitchen is made inaccessible via a child safety gate. Doors to the remaining bedrooms and bathroom have door locks and a safety doorknob cover. There are no bodies of water observed during time of visit. The fire extinguisher is rated 2A 10B: C. and is located in the kitchen. The smoke and carbon monoxide detectors meet requirements and are operational. Poisons, detergents, cleaning compounds and medications are secured inaccessible to children in care by placement in an off limit bedroom, off limit bathroom and in the off limit kitchen.

Licensee accompanied LPA on a tour of the home, as shown on the updated facility sketch. Background criminal record clearances were verified and discussed. First Aid and CPR certifications expire in June 2024. Facility has working 2A10BC fire extinguisher, smoke alarms, carbon monoxide, and the first aid kit in place. The last safety drill was on 02/27/2023. There are no bodies of water on the premises. Per the Licensee, no weapons or ammunition are housed in the facility. Licensee shall submit an updated application to the licensing department should the daycare schedule, telephone number or email address change. The daycare

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2023
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ADEN, LUCKY FAMILY CHILD CARE
FACILITY NUMBER: 376629557
VISIT DATE: 05/08/2023
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schedule is weekends 12 AM to 11:59 PM.

The Licensee and LPA reviewed the Ratio/Capacity Worksheet for a large family childcare home. The Licensee acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensee shall comply with the capacity requirements for a Small Family Child Care Home. Licensee states that all helpers shall have completed background clearances prior to their initial presence in a Family Child Care home. Licensee also states that helpers shall have a current pediatric 1st Aide/CPR card and written documentation of their possession of the necessary vaccinations and medical clearance. Licensee acknowledges that their assistants’ records will be maintained in the daycare for review by the Department.

The Licensee and adult residents in the home have criminal record clearances and/or exemptions on file. Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and adults who have contact with children, 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.

The Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate (SCCCA) information was provided. Advocate information was provided: (916) 654-1541 and [email protected] . The Licensee is already enrolled in the Department’s email notification program, so they may electronically receive program updates and changes. email list through the CCLD website, thus receives updated regulation information.

In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) of children is approved today (05/08/2023). A new license will be generated and mailed to the provider.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee Lucky Aden.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023
LIC809 (FAS) - (06/04)
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