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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191513297
Report Date: 08/23/2022
Date Signed: 08/23/2022 11:30:52 AM


Document Has Been Signed on 08/23/2022 11:30 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:JOHNSON FAMILY CHILD CAREFACILITY NUMBER:
191513297
ADMINISTRATOR:MARIE JOHNSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 569-9309
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:14CENSUS: 3DATE:
08/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Marie Johnson, LicenseeTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 08/23/2022 at 9:40 AM. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Marie Johnson. Adults in the home were discussed and all have criminal record clearance. Also present was A1, Licensee’s Assistant. There were three day care children (one of which an infant) present during today’s inspection. Licensee states that there are currently 23 children enrolled. LPA singularly toured the facility.The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are Monday thru Saturday 23 hours. Licensee understands she cannot provide care for a child longer than 23 hours. LPA discussed Overnight care procedures with Licensee, and Licensee states children use Daycare Space and Infant/Toddler Room for sleep. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 07/2022. Licensee states she has dual license for FFA.

This is a single-story home which consists of three bedrooms and three bathrooms, kitchen, living room, Infant/Toddler Room, and Daycare Space. Facility is next door and shares a driveway with KinderPrep Preschool. Areas used by the children include the living room (located to the rear of the home), Infant/Toddler Room (located in the back of the home through Living Room), Daycare Space (located to the left of Infant/Toddler Room), and Bathroom 1 (located in Daycare space). Per Licensee, areas off limits to children and parents include entire front of the home, which includes all bedrooms, two bathrooms, kitchen and dining room. LPA observed that there are multiple doors separating areas used by children and off-limits areas.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed ceiling fans
through out the home and an A/C wall unit in Daycare Space. At 9:42 AM, LPA observed a fireplace that is
Report Continues - Page 1 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 191513297
VISIT DATE: 08/23/2022
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screened off making it inaccessible to children in care. At 9:46 AM, LPA observed a wall heater in Daycare Space that is barricaded making it off limits to children in care. There is a working telephone maintained in the home. At 9:42 AMLPA observed large sectional couch and TV hanging in Living Room. LPA observed this area will also be used as a sick/isolation area. At 9:45 AM, LPA observed wooden crib, metal crib, and playpen available for infant sleep and two high chairs in Infant/Toddler Room. LPA observed soft plush toys and other age appropriate toys, free of loose and sharp parts available for children. At 9:47 AM, LPA observed Daycare Space to have child size tables and chairs, cubbies for children's belongings, puzzles, and games available for children in care. Per Licensee, they provide food for children in care and use Daycare Space to eat. At 9:49 AM, LPA observed Bathroom 1 to have general sanitation, operable toilet and sink, adequate toileting supplies, and free of hazards at time of inspection. LPA observed electrical cover outlets all through the home. Per Licensee, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock. At 9:50 AM, LPA observed a laundry closet in Daycare Space where detergents and cleaning compounds are stored in high shelf with operable door blocking access to children in care. At 10:10 AM, LPA observed more cleaning solutions stored in off limits Kitchen under cabinet sink that has operable child safety lock at time of inspection.

Per Licensee, the children will have access to backyard area for outdoor play. LPA observed outdoor play area is accessible through rear door in Daycare Space and a door in Infant/Toddler Room. At 9:52 AM, LPA observed backyard has turf grass, garden retaining walls, and adequate perimeter fencing through-out the yard. LPA observed scooters, metal climbing structures and slides with cushioning below to absorb fall available for the children in the backyard and all trees, shrubs, and plants are maintained.

At 10:12 AM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with service tag dated: 07/27/2022. At 10:06 AM, LPA observed smoke and carbon monoxide detectors are in operable condition at time of inspection. Per Licensee, First Aid kit is kept in the Daycare Space and Infant/Toddler Room. LPA observed First Aid kit. The Licensee has current Pediatric First Aid and CPR expires on 02/04/2023. Proof of immunization against influenza and pertussis were readily available but none observed for measles. The Licensee has also taken the Mandated Reporter Training on 04/28/2021.
Report Continues - Page 2 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 191513297
VISIT DATE: 08/23/2022
NARRATIVE
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Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water or firearms/weapons in the home at time of inspection.

The following were discussed:
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

Licensee (or facility representative) was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.



LPA discussed the safe sleep regulations with licensee [or facility representative] 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 as an additional resource. LPA also informed licensee [facility representative] 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.
Report Continues - Page 3 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 191513297
VISIT DATE: 08/23/2022
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LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.



Based on this information, the following deficiencies on the attached LIC 809D 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 inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Marie Johnson.


Report Ends - Page 4 of 4

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 08/23/2022 11:30 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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 191513297

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2022

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 interview and record review, Licensee did not have proof of completion for Mandated Reporter training for Assistant. This is a potential health, safety, and personal rights risk to children in care.
POC Due Date: 09/23/2022
Plan of Correction
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Licensee states she will have Assistant take training and provide proof to LPA by POC date via text.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Licensee did not have immunization records for A1 and Licensee did not have proof of immunization for Measles at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 09/23/2022
Plan of Correction
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Licensee states she will obtain records and provide to LPA via text by POC date.

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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6