Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624202
Report Date: 11/10/2015
Date Signed 11/10/2015 09:40:41 AM

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:HIBBERT, BARBARA FAMILY CHILD CAREFACILITY NUMBER:
376624202
ADMINISTRATOR:BARBARA HIBBERTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 761-9982
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 3DATE:
11/10/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Barbara HibbertTIME COMPLETED:
09:50 AM
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(3) LPA Angel Richards arrived at the home to conduct an Annual/Random visit. The single story home was toured and inspected to ensure an environment safe for the care and supervision of children. There are no pets in the home. The hours of operation are: 6am-6pm Monday-Friday. Present were the Licensee, volunteer Shanise and 3 day care children. Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room, family room, bathroom, daycare room, and kitchen. Off limits areas include the garage by use of a child proof door knob and 4 bedrooms (1 bathroom) by use of a gate. The fireplace is screened in the living room. The home has a fenced side yard (right of home) available for outdoor activities. The backyard is off limits by use of a gate. There is a covered/locked hot tub in the backyard. There is also a BBQ grill and trampoline. All of which are off limits to children in care. The fire extinguisher, carbon monoxide detector and smoke detector meet requirements and are operational. The last disaster drill was conducted on 10/28/15. All hazardous items were out of reach of children. There are no weapons in the home. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances. Licensee’s First Aid and CPR certifications expire on 8/15/2017. Helper Andrea's First Aid and CPR certifications expire on 11/1/2016. Per licensee Shanise is not left alone with the children. Licensee maintains a current facility roster. LPA reviewed a sample of Children's Records which contain the Notification of Parents' Rights and the Immunization records as required.

Provider is reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, keep items that read “keep out of reach of children” inaccessible to children in care, post all required forms, ensure that all adults living or working in the home have criminal background clearances prior to living or working in the home. LPA reviewed SIDs, SUID’s, and Back to Sleep. Also that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not permitted in the day care. (LPA provided the visual for prohibited items & the LIC 311D)

No deficiencies are cited. NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Mary A RichardsTELEPHONE: 619-767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2015
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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