Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814955
Report Date: 01/12/2016
Date Signed 01/13/2016 09:58:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MALONE FAMILY CHILD CAREFACILITY NUMBER:
364814955
ADMINISTRATOR:MALONE, BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 843-9656
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 6DATE:
01/12/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Brenda MaloneTIME COMPLETED:
12:15 PM
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3. A random visit is being conducted as a compliance review. Licensing Program Analyst (LPA) James Wilkerson, toured the facility, inside and out. Present during this visit were: Brenda Malone & Roland Malone. The following was observed:

· The facility is operating within the licensed capacity and appropriate ratios
· Appropriate supervision provided during visit
· A working telephone is present
· Appropriate fire extinguisher, smoke & carbon monoxide detectors present
· The fireplace is properly screened
· The facility has adequate heating and ventilation
· There stairs are barricaded
· All hazardous items inaccessible
· Toxins are locked
· There are no guns or weapons at this facility per Brenda Malone
· Outdoor play area is fenced
· No bodies of water, backyard toured on this date by LPA
· Clean, safe and age appropriate toys
· Pediatric CPR and First Aid Card expires on 12/14/17
· Last Fire/Earthquake Drill conducted on 10/01/15
· Licensee has required contact information in case of an emergency
· Resident and/or staff records reviewed on 01/11/16 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
· Children's immunization records are updated and complete
SUPERVISOR'S NAME: Marianne DonleyTELEPHONE: (951)782-4200
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2016
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MALONE FAMILY CHILD CARE
FACILITY NUMBER: 364814955
VISIT DATE: 01/12/2016
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INCIDENTAL MEDICAL SERVICES PLAN. In accordance with California Health & Safety Code 1597.54(h) - The Incidental Medical Service Plan of Operation includes administering: Blood Glucose Testing, Inhaled Medicines (asthma/bronchitis), Epi-Pen, Glucagon, G-Tube, and/or carrying out Medical Orders.
Incidental Medical Services Plan were discussed with Licensee on this date and time.
Licensee understands that a written Plan of Operation (POO) must be submitted and approved by the Department within 30 days of this report to administer any of the above medications/services to the children in care and shall include: storage of medication and equipment/supplies, and documentation in the children’s, personnel, and administrative records. Please refer to Title 22, Division 12, Chapter 1, Article 03, Regulation 101173(c) Plan of Operation.

This facility declines to provide Incidental Medical Services - IMS at this tim

An exit interview was conducted, Notice of Site visit posted and a copy of this report was provided to the licensee.

During the exit interview, the Licensee, Brenda Malone confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

A copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Marianne DonleyTELEPHONE: (951)782-4200
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2016
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MALONE FAMILY CHILD CARE
FACILITY NUMBER: 364814955
VISIT DATE: 01/12/2016
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· The home has a current roster of the children.
· The licensee does provide the children's parent's or representatives with a copy of the Family Child Care Home Notification of Parent's Rights.
· AB 633 – Parent Notification Requirements effective January 1, 2007 – were explained during this visit.
· AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Sections 1596.99(c)/1597.58(c) – it was explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil penalty of $150 per day per violation will be assessed until corrected.
· AB 2084 - Nutritious Beverages in Child Care Facilities effective January 1, 2012 - was explained that only low-fat or non-fat milk is to be served to children 2 years of age or older; and limit juice to one serving of 100% juice per day; serve no beverages with added sweeteners; and water must be available and accessible to children throughout the day.
· AB 2386 – Carbon Monoxide Detector Regulations went into effect January 1, 2015 – In accordance with California Health and Safety Code Section 1597.543 – every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing Section 13260) of Part 2 Division 12.
· AB 2621 – Smoking prohibition on the premises of Family Child Care Home, effective January 1, 2015 - This bans smoking tobacco in a home that is licensed as a family child care home, and in those areas of the family child care home were children are present. This change in law was based on demonstrated negative health effects of second and "thirdhand" smoke on children. Thirdhand smoke generall refers to the residue from tobacco smoke that sticks to surfaces after the secondhand smoke has cleared.
· AB 1918 - Health and Safety Code 1596.819. (a) Except as otherwise prohibited by law, the department shall post licensing information on it's internet web site as follows: Section 1596.750, the information for family child care homes shall include the licensed capacity of the facility, the status of the department shall update the information posted on at least a monthly license and the number of site visits, including the number of citations, substantiated and inconclusive basis.
SUPERVISOR'S NAME: Marianne DonleyTELEPHONE: (951)782-4200
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2016
LIC809 (FAS) - (06/04)
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