Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403006
Report Date: 08/06/2015 12:00:00 AM
Date Signed 08/06/2015 06:42:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:OLMSTEAD FAMILY DAY CAREFACILITY NUMBER:
197403006
ADMINISTRATOR:OLMSTEAD, MAY A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 385-1147
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:14CENSUS: 13DATE:
08/06/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:48 PM
MET WITH:May OlmsteadTIME COMPLETED:
04:05 PM
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Licensing Program Analysts (LPAs) Myriam SaulloLuga and Tiffanie Tran met with licensee to conduct an annual random visit. Licensee notified LPAs that her current operation hours are still from 6 AM till 9 PM. LPAs inspected the facility indoor and outdoor. All required postings such as the facility license, etc. were visible. LPAs reviewed the fire drill log and noted that a fire drill has been done on a monthly basis. The last fire drill was completed on 7/31/2015. There were 13 children (including 2 infants and 3 school age children) present at the facility. Licensee's husband and an assistant were present during the visit. All adults at the facility were fingerprint cleared and associated to the facility. This is a one story home with 3 bedrooms, 2 bathrooms, a living room, den, dining room, kitchen, front and back yard. LPAs observed a working smoke detector, carbon monoxide detector, fully charged 2A10BC fire extinguisher and a working telephone. All electrical outlets, detergents, cleaning supplies and medications were stored to be inaccessible to children. LPAs inspected the bathroom utilized by children and it was clean and orderly. Child care is conducted in two bedrooms, living room, den and the dining room. The master bedroom is off limit to children. All kitchen cabinets/drawers had latches on.
Per the licensee, there are no firearms on the premises. LPA observed a first aid kit, age appropriate toys and mats/cribs for napping. Licensee, licensee's husband and assistant are certified for CPR/first aid, certificate expires in January 2016. The outdoor play area/back yard was inspected and was free of hazardous materials and was equipped with age appropriate toys/ structure/equipment in good condition. Licensee indicated that she does not provide incidental medical services.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2015
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: OLMSTEAD FAMILY DAY CARE
FACILITY NUMBER: 197403006
VISIT DATE: 08/06/2015
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LPAs reviewed children records and they were all complete.
Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), No smoking is allowed on a day care premises, Never shake a baby to prevent Shaken Baby Syndrome, Only children eating may be in high chairs, and care seats are to be only used for transportation. Provider is required to wash hands after every diaper change.
No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was submitted to licensee.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2015
LIC809 (FAS) - (06/04)
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