Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018568
Report Date: 07/08/2015 12:00:00 AM
Date Signed 07/08/2015 05:08:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DUNCAN FAMILY CHILD CAREFACILITY NUMBER:
198018568
ADMINISTRATOR:JAMISHA JENEE DUNCANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 326-2619
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY:14CENSUS: 0DATE:
07/08/2015
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Jamisha Jenee DuncanTIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted an announced pre-licensing visit today. LPA met with applicant Jamisha Jenee Duncan, who guided analyst on a tour of the facility. Also present was applicant's minor child. Family members residing in the home are 1 adult and 1 minor child.

All areas identified on the facility sketch were inspected. This is a single story home which consists of 3 bedrooms, 1 bathrooms, kitchen, dining room, living room, play area, detached garage, backyard (fenced). Child care will take place in the living room, dining room, bathroom in hallway, playroom and backyard. These areas were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating.

The outdoor play area (backyard) was inspected for safety. Licensee understands outdoor play time requires supervision at all times.

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible.

Areas off limits to children and parents include: The licensee's bedroom, minor child's bedroom and garage. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.
SUPERVISOR'S NAME: Joan HayesTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2015
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DUNCAN FAMILY CHILD CARE
FACILITY NUMBER: 198018568
VISIT DATE: 07/08/2015
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LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home. The following required forms were explained and provided to the applicant during this visit.

Children’s Forms/Records:
Parent Notification Additional Children in Care (LIC 9150); Affidavit Regarding Liability Insurance (LIC 282); Consent For Emergency Medical Treatment (LIC 627); Consent/Verification for Nebulizer (LIC 9166); Identification and Emergency Information (LIC 700); Notification of Parents’ Rights (LIC 995A); Caregiver Background Check Process (LIC 995E); Family Child Care Awareness Information (LIC 9212); Photocopy of child’s Immunization Record (yellow record); California School Immunization Record (PM 286); Acknowledgement of Receipt of Licensing Report (LIC 9224).

Facility Forms/Records:
Proof of current Pediatric first aid and CPR must be available at all times; Unusual Incident/Injury Report (LIC 624B); Memo dated 07/11/2003 – Reporting Requirements for FCC Home Licensees; Child Care Roster (LIC 9040); Property Owner/Landlord Consent Form (LIC 9149); A copy of your Control of Property should be readily available.

Information Required to be Posted in Your Family Child Care Home:
Facility License; Notification of Parents’ Rights Poster (PUB 394); Emergency Disaster Plan (where readily available in case of an emergency; Earthquake Preparedness Checklist (LIC 9148) – attach to Emergency Disaster Plan; Once licensed – Notice of Site Visit must be posted for 30 days and any report documenting a Type A violation must be posted.

Staff Forms/Records - any assistant present must have the following on file:
Proof of TB clearance (within one year); Notice of Employee Rights (LIC 9052); Criminal Record Statement (LIC 508); Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).
SUPERVISOR'S NAME: Joan HayesTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2015
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DUNCAN FAMILY CHILD CARE
FACILITY NUMBER: 198018568
VISIT DATE: 07/08/2015
NARRATIVE
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Per applicant, there are no firearms or weapons in the home. There were no bodies of water observed on the premises. There were toys observed during this visit. The valve on the required 2A:10BC fire extinguisher indicates fully charged. Smoke detectors/Carbon Monoxide in the dining room/living room were tested, and are in operable condition.

Applicant has completed the Health and Safety Training, pediatric CPR and First Aid training as indicated on the certificate. Pediatric First Aid and CPR expires 06/3/17. There are emergency supplies on the premises.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

If an individual has already obtained a criminal record clearance with the Department, the criminal record clearance may be transferred. A Criminal Background Clearance Transfer Request form - LIC 9182 must be submitted to transfer any criminal record clearances. Prior to submitting this form, you must call our office to verify that the individual has an active criminal record clearance.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

The following was also discussed: CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal record transfer requirements, criminal record and child abuse clearances.
SUPERVISOR'S NAME: Joan HayesTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2015
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DUNCAN FAMILY CHILD CARE
FACILITY NUMBER: 198018568
VISIT DATE: 07/08/2015
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Any assistant left alone with children must have proof of current Pediatric First Aid and CPR on file (AB 1368).

LPA reviewed and provided a copy of 'Tips for Licensees to Prevent Heat-Related Illnesses'.

Applicant has been advised of the following:

· Any pets are recommended to be isolated from children in care.
· 101217 (g)(9)(A)(1) - Fire and earthquake drills must to be conducted and documented every six months. Documentation must be readily available.

Control of property was established. Per applicant, there are no dual licenses at this address.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

Once licensed, the applicant is required to adhere to the terms and limitation as stated on the license.

The applicant will be approved for a Large family child care license.

Exit interview was conducted with Jamisha Duncan who is in agreement with the above. A copy of this report and all other Licensing reports must be made available to the public for 3 years.
SUPERVISOR'S NAME: Joan HayesTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2015
LIC809 (FAS) - (06/04)
Page: 4 of 4