Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416722
Report Date: 08/15/2016
Date Signed 08/15/2016 03:24:18 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:HOBB FAMILY CHILD CAREFACILITY NUMBER:
197416722
ADMINISTRATOR:HOBB, AMELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 821-8977
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:14CENSUS: 9DATE:
08/15/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Amelia HobbTIME COMPLETED:
03:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . LPA met with the licensee and toured the home inside and outside. LPA observed 9 children ( including 3 infants and 6 preschoolers) in the facility. The licensee was present with her two assistants ( fingerprint cleared and associated). The licensee's home is a two story 5 bedroom, 3 bathroom home with living room, dining room, kitchen, den (Day-care room) and attached garage. The garage is used for child care activities. There are walls that divide the garage into 3 smaller rooms plus a bathroom. There is a pool in the back yard enclosed by a 5 foot, wrought iron fence. There is an above ground spa located in the fenced pool area. The pool gate was tested and observed to be self-closing and self-latching. Additionally, licensee carries a key with her for the padlock that is kept on the pool gate. Family members residing in the home include 2 adults (licensee and and 2 minor children. All adults have clearances and are associated to the facility.
Main care is provided in the den (day care room) located at the rear of the home. Child care activities are conducted in the converted garage. Children have access to the living room, dining room, kitchen and 2 bathrooms; one located inside the garage and the other in the hallway. Children also use one bedroom located near the den for napping. Children eat either outside in the back yard or in the den. Off limit areas include the entire second floor. Licensee has a safety gate at the bottom of stairs. The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The kitchen cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the kitchen.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2016
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: HOBB FAMILY CHILD CARE
FACILITY NUMBER: 197416722
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2016
Section Cited
102416(c)
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:Licensee is required to maintain current Pediatric CPR and First Aid certifications at all times..
Licensee was unable to demonstrate current proof of CPR/First Aid Certificates
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Licensee will provide proof of current Pediatric CPR & Pediatric First Aid certifications or registration for by 08/22/2016
Type B
08/22/2016
Section Cited
102417(g)(10)
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OPERATION OF FAMILY CHILD CARE HOME: LPA observed a baby exersaucers and a baby bouncer in the facility. The baby exersaucer has the potential to cause bodily harm to children in care. LPA immediately had licensee remove baby bouncer from the site.
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Licensee agrees to immediately take the baby bouncer/rocker and the exersucers out of the child care premises.
Corrected during the visit.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2016
LIC809 (FAS) - (06/04)
Page: 3 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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: HOBB FAMILY CHILD CARE
FACILITY NUMBER: 197416722
VISIT DATE: 08/15/2016
NARRATIVE
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There is a working smoke/carbon monoxide detectors located in the play room. Licensee was unable to demonstrate current proof of CPR/First Aid Certificates ( expired 03/2015, assistant's CPR/First Aid expired 08/2016). The First Aid kit was observed, and complete. LPA observed the fire drill log. The fire drills are done every month.
LPA observed toys and furniture that were age appropriate and in good repair. LPA observed a baby exersaucers and a baby bouncer in the facility. The baby bouncer and exersaucers have the potential to cause bodily harm to children in care.
LPA toured the backyard and found it to be fully fenced.
Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a).

A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.

Incidental Medical Services were discussed. Per licensee incidental medical services are not and will not be provided.

Licensee is advised to visit www.shotsforschool.org for Immunization information.
SB 277 - require all children attending day care or school based programs to be immunized and will eliminate personal/religious belief exemptions

Exit interview was conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2016
LIC809 (FAS) - (06/04)
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