Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614962
Report Date: 07/16/2015 12:00:00 AM
Date Signed 07/16/2015 03:28:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:FORD, JANICE FAMILY CHILD CAREFACILITY NUMBER:
376614962
ADMINISTRATOR:JANICE FORDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 449-1362
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:14CENSUS: 11DATE:
07/16/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Janice FordTIME COMPLETED:
03:35 PM
NARRATIVE
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(2) LPA Richard Gumienny made an unannounced annual/random inspection. Met with Licensee Janice Ford who was supervising eleven (11) day-care children (1 of whom was under 24 months of age). Also present at the home was the Licensee's spouse, Clair, & employee, Emily Wolf. 2 children were picked up during the visit. Licensee stated that there are no new adults living or working in the home over the age of 18 years. A review of staff records on 7/16/15 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances and T.B. test results prior to working and/or residing in the home. Licensee & Emily Wolf have current CPR & first aid certifications valid through 10/2016. This two story, 5 bedroom, 4 bathroom home was inspected. The following areas will be used for day care: living room, family room, side room (adjoining family room),dining room, 1 downstairs bathroom (hall), & fully fenced back yard. Second story is off-limits and inaccessible by safety gate at stairwell. The garage, downstairs bedroom & bathroom & kitchen, are off-limits and inaccessible to children by door lock, baby gate or door knob cover. The home has a properly barricaded fire place. There is an operational smoke alarm and fire extinguisher as well as carbon monoxide detector maintained in the home. There are ample space, toys, play equipment and napping equipment for children. Licensee stated there are no weapons or bodies of water present on the premises. The home has adequate heating and ventilation. The home has a working telephone. Children's records, & facility roster were reviewed. The last disaster drill was conducted and documented on 6/8/15.

Licensee stated that she is not currently providing Incidental Medical Services to any children in care. LPA advised that should medical services be provided in the future that the Licensee must create a plan of operation to describe these services. Licensee referred to CCL website for further information.


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SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Richard GumiennyTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2015
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: FORD, JANICE FAMILY CHILD CARE
FACILITY NUMBER: 376614962
VISIT DATE: 07/16/2015
NARRATIVE
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LPA reviewed the following with Licensee: Capacity limitations, supervision, unusual incidents, mandated reporting, Assembly Bill 633, SIDS, Shaken Baby Syndrome, Megan's law. Licensee is reminded that corporal punishment, smoking, baby walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day-care operation

Refer to LIC 809D for deficiency citation(s). Provided licensee with appeal rights. Exit interview conducted.


Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ My CCL Web Portal: www.myccl.ca.gov
SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Richard GumiennyTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2015
LIC809 (FAS) - (06/04)
Page: 2 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: FORD, JANICE FAMILY CHILD CARE
FACILITY NUMBER: 376614962
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2015
Section Cited
102417(g)(8)
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102417(g)(8) Operation of a Family Child Care Home. All homes shall have a current roster of the children.
-Facility did not have a current roster of children in care.
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Licensee understands that a current roster is necessary and used existing children records to update the roster during the visit. POC cleared during visit 7/16/15.
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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: Debbie HanesTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Richard GumiennyTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2015
LIC809 (FAS) - (06/04)
Page: 3 of 3