Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403006
Report Date: 08/24/2017
Date Signed 08/24/2017 10:42:33 AM

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:
8183851147
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:14CENSUS: 2DATE:
08/24/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:May Olmstead, LicenseeTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Tiffanie Tran conducted an annual random inspection. LPA met with May Olmstead, licensee and toured areas of the home. During the visit present were licensee and an employee Alejandra Varas with 2 children in care 2 infants. All adults have fingerprinted cleared and associated to the licensed facility. LPA observed proper care and supervision of children and ratios.

This is a single dwelling home consists of 3 bedrooms, 3 bathrooms, kitchen, family room, living room and a patio. Child care mainly conducted in family room and patio. Children do have access to one bathroom. The rest of the areas in the home are off-limits to children. Licensee acknowledged that children may never enter these off-limit areas. Per licensee, children play in the backyard. LPA observed to be fenced in, safe and clean. LPA observed no bodies of water on this property.

LPA observed all posting requirements by the entrance. Licensee had current CPR/First Aid certificates (Exp. 1/2018), fire extinguisher, carbon monoxide and smoke detector meet regulations. Cleaning materials and medications are inaccessible, there is a working telephone, and toys appear to be safe. Licensee stated there are no fire arms in the home. The home conducted emergency disaster drill on a monthly basis. LPA reviewed children's record to be complete and orderly. LPA provided the Licensing Agency website (www.cdss.ca.gov), so the licensee may obtain updated licensing information, regulations, and forms.

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
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2017
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: 08/24/2017
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During the inspection, LPA observed baby cribs were made custom made. The cribs were all enclosed with woods unable to see through. LPA advised licensee that baby need to sleep crib and able to see through for the purpose of proper care and supervision. Licensee agrees to modify the cribs to make it see through then submit photo images to LPA. In addition, LPA observed two infant bouncers. Licensee immediately removed the infant bouncers in the off-limit area.

LPA discussed and provided the safe sleep for baby pamphlet. LPA recommend that babies sleep safest on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep-related causes of infant death. Baby's sleep area shall have no bumpers, pillows, blankets, or toys and direct supervision is required during sleep time.

Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the Department’s website at www.cdss.ca.gov including information on the Live Scan application (LIC 9163).

LPA discussed AB633 and informed licensee that, upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Licensee is reminded that smoking is prohibited on the premises during hours of operation.

Type A deficiency is cited during today’s visit. An exit interview conducted. Licensee had a copy of this report.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2017
LIC809 (FAS) - (06/04)
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