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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191231930
Report Date: 07/01/2022
Date Signed: 07/01/2022 11:01:29 AM


Document Has Been Signed on 07/01/2022 11:01 AM - It Cannot Be Edited

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:ALEXANDER FAMILY DAY CAREFACILITY NUMBER:
191231930
ADMINISTRATOR:ALEXANDER, LETHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 684-1618
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:14CENSUS: 0DATE:
07/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Letha Alexander - LicenseeTIME COMPLETED:
11:14 AM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced random 4-5 Year inspection to the above facility. At 9am LPA met with licensee, Letha Alexander. The licensee states that she currently has 6 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 6am-5:30am, Monday-Sunday.

This is a one-story home which consists of 2 bedrooms, 1 bathroom, kitchen, dining room, living room, family room (daycare room), front yard and backyard (fenced). The children use living room, daycare room, bathroom, and backyard. Per licensee, areas off limits to children and parents include: the bedrooms and front yard. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 2 adults and 0 children currently live in the home. Persons living in the home are identified on the attached LIC811. Licensee states that she currently has one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT


At 9:05am, LPA was lead on a tour of the facility by the licensee. Upon entry into the facility, LPA observed Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted in the living room. LPA observed a fireplace sealed off and made in accessible to children in care. The tour continued through the dining room. At 9:10am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 09/01/2022, as indicated on receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.
REPORT CONTINUES PAGE 1 of 4
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6


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: ALEXANDER FAMILY DAY CARE
FACILITY NUMBER: 191231930
VISIT DATE: 07/01/2022
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There are first aid supplies available in the dining room. The kitchen was reviewed next. Sharp knives were observed to be kept on top of the refrigerator and out of reach of children. LPA reviewed the bathroom that was observed to be clean and free of hazards. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. There was a child lock on the cabinet under the sink. The back family room is used as a "daycare room." LPA observed age appropriate toys and equipment for children to use. LPA observed napping equipment in the form of cots. Equipment is stored in the daycare room. Smoke and carbon monoxide detectors were tested and are operable. Per licensee, the front living room will be used as an area for an ill child until an authorized representative comes to pick up child. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The licensee states that there is a land line on the premises.

At 9:30am, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There was a small playhouse, patio deck, small play structures, bikes, basketball hoop, and tables. Children in care are able to access all equipment. The detached garage and shed in the back corner are made inaccessible to children in care. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 08/2022. Licensee does not have a complete mandated reporter training. Per licensee they were not aware of what Mandated Reporter was. LPA explained the child abuse training and informed them that it needs to be completed every two years. The licensee does not have proof of immunization against influenza, tuberculosis, pertussis, and measles at the facility. The facility inspection report from 03/2018 notes that the facility provided proof of immunizations. LPA is providing a technical violation. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment.


REPORT CONTINUES PAGE 2 of 4
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: ALEXANDER FAMILY DAY CARE
FACILITY NUMBER: 191231930
VISIT DATE: 07/01/2022
NARRATIVE
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The following was discussed:
-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There is one small dog on the premises. Dog is kept separate from children when they are present
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

Infant Care: Licensee states that they are not currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the daycare room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):


The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process



REPORT CONTINUES PAGE 3 of 4
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: ALEXANDER FAMILY DAY CARE
FACILITY NUMBER: 191231930
VISIT DATE: 07/01/2022
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LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Licensee Letha Alexander, and Plan of Corrections were reviewed and developed. A copy of the report was provided.



END OF REPORT PAGE 4 of 4
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 07/01/2022 11:01 AM - It Cannot Be Edited

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: ALEXANDER FAMILY DAY CARE
FACILITY NUMBER: 191231930

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on review and interview, the licensee did not comply with the section cited above where the licensee does not have a completed mandated reporter Child Care Provider training proof, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Per licensee, they will complete the Mandated Reporter Child Care Provider (AB1207) Training and submit proof by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6