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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602074
Report Date: 03/02/2022
Date Signed: 03/07/2022 02:38:49 PM


Document Has Been Signed on 03/07/2022 02:38 PM - 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:FORD FAMILY DAY CAREFACILITY NUMBER:
191602074
ADMINISTRATOR:FORD, CHARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 989-0288
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:12CENSUS: 11DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Charlene Ford, LicenseeTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced required 1-year inspection to the above facility on March 2, 2022 at 11:27am. LPA arrived at the facility at 11:27AM, identified self and met with Charlene Ford, Licensee who guided analyst on a tour of the facility. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. LPA observed that also present during this inspection, was assistants Taylor Williamson and Judith Velazquez. LPA observed 11 children upon arrival. Per Licensee, operation hours are 6:00AM to 7:00PM. There are 12 children that are currently enrolled. A current children’s roster was available for review.

This is a one-story home which consists of 3 bedrooms, 2 full bathrooms, kitchen, dining room, laundry and bathroom in one room, additional family room, detached garage, front yard, and backyard (fenced). The children use the bathroom in the additional family room by kitchen. The facility does not have a fireplace. Per Licensee, areas off limits to children and parents include: all bedrooms, front living room, and master bathroom, and front yard. The licensee provides food for children in care.
Individuals who reside in the home were noted and discussed. Per Licensee, they currently have two assistants.
Licensee 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
Licensee states that there no firearms stored in the home. ----Page 1 of 5
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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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Document Has Been Signed on 03/07/2022 02:38 PM - 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: FORD FAMILY DAY CARE
FACILITY NUMBER: 191602074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation during inspection, licensee was unable to produce the requested documents for facility records, child files, and staff records. The licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/04/2022
Plan of Correction
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Licensee agrees to gather the missing records and the TSP program to assist her. Licensee will provide LPA, proof all of the missing records by 04/04/2022.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, records were not available during inspection, the licensee did not comply with the section cited above i which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/04/2022
Plan of Correction
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Licensee will provide LPA with all missing records by 04/04/2022

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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
LIC809 (FAS) - (06/04)
Page: 6 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: FORD FAMILY DAY CARE
FACILITY NUMBER: 191602074
VISIT DATE: 03/02/2022
NARRATIVE
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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via landline and a cellphone that is used. There is ventilation and heating via wall unit. Safe toys play equipment and materials were observed.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. 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 restroom that children use was observed to be safe and sanitary.

The licensee’s fire extinguisher is a 3A 40 BC fire extinguisher and is new. The licensee provided a receipt dated 06/27/21 indicates fully charged. Licensee buys a new fire extinguisher yearly. Smoke and carbon monoxide detectors were tested to ensure that they are operable. LPA advised that Licensee to write the expiration date of the carbon monoxide detector on the back.

Licensee does not have any infants ages 0 to 12 months enrolled and does not want to enroll that age group. Licensee is aware of the safe sleep regulations.

LPA advised Licensee to read the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. -----Page 2 of 5
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC809 (FAS) - (06/04)
Page: 4 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: FORD FAMILY DAY CARE
FACILITY NUMBER: 191602074
VISIT DATE: 03/02/2022
NARRATIVE
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LPA also informed licensee 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.

Currently, children are using the back yard for outdoor play time. Sometimes the licensee walks the children to the neighborhood park for playtime. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. The licensee states that supervision is always provided.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.



The licensee completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 07/02/2023. There are first aid supplies available. LPA advised that if a child shows signs of illness, he/she/they shall be separated from other children.

LPA was unable to review the facility records and children’s records currently. LPA will refer the licensee for TSP program for recordkeeping.
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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC809 (FAS) - (06/04)
Page: 5 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: FORD FAMILY DAY CARE
FACILITY NUMBER: 191602074
VISIT DATE: 03/02/2022
NARRATIVE
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The licensee’s and staff’s immunization records were not available for review at this inspection.
LPA observed that the Licensee and one assistant do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. Second assistant will need to provide LPA with the certificate by 03/07/22.

LPA issued a Confidential Names List (LIC 811) The children’s records were not available for review during this inspection.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Licensee could not locate the drill log for the inspection.

There is one dog and one cat on the premises. ----

LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family childcare facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. page 4 of 5
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
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: FORD FAMILY DAY CARE
FACILITY NUMBER: 191602074
VISIT DATE: 03/02/2022
NARRATIVE
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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/inspection-process

The following deficiencies listed on the attached 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Charlene Ford.
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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6