Pre-licensing visit·April 24, 2025

On April 24, 2025, at 9:10 am, Licensing Program Analyst (LPA) Cindy Hamilton and Licensing Program Manager (LPM) Carlos Martinez conducted an announced pre-licensing inspection for a large family childcare at the above home. LPA met with Applicant Cynthia Wilburn-Polk, who guided LPA on a tour of the home. There were no children present when LPA and LPM arrived. Applicant is applying for a large child care license. Per Applicant, hours of operation will be Monday through Friday from 5:30 am to 6:30 pm. Applicant states they will provide care for children 2 years old 15 years of age. This is a two-story home consisting of five bedrooms, 4.5 bathrooms, a living room, kitchen, dining room, daycare room, office, laundry room, loft, front yard and backyard. The home was inspected for safety, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children are kept in laundry room and garage which is a key locked cabinet and door. Areas used by children include: The family room, bathroom #2, back day care room (located at the rear of the home), and backyard. Areas off limits include: entire second floor, laundry room, office, dining room, living room, and kitchen. Off limit areas by supervision. Knives and other sharp utensils are locked in the pantry. Cleaning products are made inaccessible by a key lock. The home is clean, neat, and orderly, there are outlet covers throughout the home. Smoke/carbon monoxide detector was observed, tested by applicant, and found to be operable. Applicants have completed the required preventative health and safety course which includes nutrition and prevention of lead exposure, and the Pediatric First Aid and CPR. Applicants have required proof of immunizations on file. Proof of Mandated Reporter Training was also provided. LPA observed age-appropriate toys and learning materials. The required (2A-10BC) fire extinguisher was observed in the dining room and living room. LPA reminded applicant that the fire extinguisher must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, batteries should be replaced. Per Applicant, there are weapons or firearms in the facility. Firearms are kept in key locked safe and that the ammunition is stored separately from the firearm. According to the applicant, the children will use the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA noted that the yard contains toys and other play materials. Additionally, LPA observed an gated play area on side of home. No hazardous objects were observed in the outdoor area. There are pools, spas, or other bodies of water. LPA and LPM inspected the backyard, inspecting the pool and the fence that surrounds it. The pool has a sturdy 5-foot mesh fence that is ASTM International Standard F2286 compliant that surrounds the entire pool and has self-latching and self-closing gate that swings away from the pool. The lock on the gate is positioned 60 inches from the ground. Licensee has also purchased a in pool alarm that detects movement inside pool water and is in compliance with ASTM International Standard F2208. In addition, LPA & LPM observed safety equipment to include a life ring with diameter of 17 inches labeled approved by United States Coast Guard and a non-adjustable rescue pole that is 12 feet in length with a body hook. LPA did not observe any items or objects near fencing that would reduce the fence\342\200\231s height to less than 5 feet or make fence climbable by a child under six years old. LPA also reviewed the daily pool inspection log. The pool fencing meets Title 22 regulations at this time. In addition, licensee has installed audio alarm on the windows and sliding glass door that leads out to pool area between the home and the mesh-fenced pool. The backyard is fenced with 5ft wood fencing around all sides of the home. LPA informed the applicant that a daily pool inspection log is required to ensure all safety measures are in place before the facility opens. This log was reviewed and advised it must be available for the department upon request. The isolation area for a sick child waiting to be picked up will be in the rear daycare room, away from other children. LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children\342\200\231s forms/records, facility forms/records, and information to be posted. The applicant provided proof of control of property. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. LPA informed Applicant of their reporting requirements. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. The Duty Officer is available to answer questions Monday \342\200\223 Friday 8:00am to 5:00pm at: 951-782-4200. In addition, a report can be emailed to UnusualIncidentReportsDO10@dss.ca.gov . Fire and safety drills must be performed every six months and documented for review by the Department. Smoking is not allowed in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present. A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. Changes should be reported to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from the home. Applicant states they will provide food for the children. CHILDREN'S RECORDS REQUIREMENTS: \342\200\242 LIC 700 Identification and Emergency Information \342\200\242 LIC 627 Consent for Emergency Medical Treatment \342\200\242 LIC 282 Affidavit Regarding Liability Insurance \342\200\242 LIC 9150 Parent Notification Additional Children in Care \342\200\242 LIC 9927 Individual Infant Sleeping Plan \342\200\242 LIC 995A Notification of Parent\342\200\231s Rights \342\200\242 Immunization Record FACILITY RECORDS: \342\200\242 LIC 624B Unusual Incident/Injury Report \342\200\242 LIC 9040 Child Care Facility Roster \342\200\242 LIC 9052 Employee Rights, \342\200\242 LIC 9108 Statement Acknowledging Requirement to Report Child Abuse \342\200\242 LIC 9149 Property Owner/Landlord Consent Form \342\200\242 LIC 9151 Property Owner/Landlord Notification Form \342\200\242 Proof of current pediatric CPR and First Aid Certificates \342\200\242 Copy of your deed or lease/rental agreement \342\200\242 Documentation of Fire and Disaster drills \342\200\242 Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza \342\200\242 Mandated Reporter certificate \342\200\223 www.mandatedreporterca.com \342\200\223 must be renewed every two (2) years FORMS TO BE POSTED \342\200\242 LIC203 Facility License \342\200\242 PUB394 Notification of Parents Rights Poster \342\200\242 PUB 475 1-844-LET-US-NO \342\200\242 LIC 610A Emergency Disaster Plan (Recommended) \342\200\242 LIC 9148 Earthquake Preparedness Checklist (Recommended) Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm . Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and- resources /safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. On 04/21/2025, the California Attorney General - Megan\342\200\231s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. The application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12 or 14 with parent notification. An exit interview was conducted, and a copy of this report was reviewed with and handed to Cynthia Wilburn-Polk.