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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609128
Report Date: 09/07/2022
Date Signed: 09/07/2022 02:08:03 PM


Document Has Been Signed on 09/07/2022 02:08 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:WIENER FAMILY DAY CAREFACILITY NUMBER:
191609128
ADMINISTRATOR:GILLIAN DUMAS WIENERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 452-5740
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:12CENSUS: 9DATE:
09/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Guillan WeinerTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Doris Whitmore, conducted an unannounced year required Visit and was met by Licensee Gillan Wiener., who guided analyst on a tour of the All present were 1 staff member and. LPA was guided on a tour inside and outside of the home. There were 9 children and 1 assistant present at the time of the visit. LPA Whitmore verified that all adults present in the home has fingerprint clearance and are associated to the facility. Days and hours of the operation are Monday through Friday from 8:30a.m. to 2:00p.m. Children bring their own lunch, and the facility provides one snack.

All areas identified on the facility sketch were inspected. This is a single-story dwelling with 2 bedrooms and 1 bathroom. The following areas are designated as off limits in the Family Child Care Home is the main home. The primary area where children are cared for is located in the childcare room/activity area located in the back yard area. Licensee has a copy of the Certificate of occupancy for the addition of the Child Care room from 2008. There are educational and age-appropriate toys for the children to utilize. At the time of the site visit, LPA observed that children were engaged in the backyard in different areas for free play.



The bathroom utilized by the children in care is located in the childcare room area, there are 2 toilets and 2 sinks. The backyard/play area was inspected. Licensee has a play apparatus in the backyard area for the children and licensee has cushioning under the play apparatus. There are no bodies of water in the Family Child Care Home.

LPA observed a working smoke detector, carbon monoxide detector, fully charged 2A10BC fire extinguisher and a working telephone. There was good lighting and ventilation at the facility as well. All electrical outlets were covered with plastic covers. All detergents, cleaning supplies are stored in well latched cabinets. Sharp objects, including knives are stored in well latched cabinets in the kitchen. Medications are stored away from children’s reach. Per the licensee, there are no firearms on the premises. LPA observed a first aid kit and age-appropriate toys.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WIENER FAMILY DAY CARE
FACILITY NUMBER: 191609128
VISIT DATE: 09/07/2022
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The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibly to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed a working smoke detector, carbon monoxide detector, fully charged 2A10BC fire extinguisher and a working telephone. There was good lighting and ventilation at the facility as well. All electrical outlets were covered with plastic covers. All detergents, cleaning supplies are stored in well latched cabinets. Sharp objects, including knives are stored in well latched cabinets in the kitchen. Medications are stored away from children’s reach. Per the licensee, there are no firearms on the premises. LPA observed a first aid kit and age-appropriate toys.

LPA observed outdoor play area is fully fenced and is free from defects or dangerous conditions. No pools are spas or similar bodies of water observed during the inspection. LPA observed Child Care Facility Roster LPA reviewed 10 children files and 2 staff files. LPA did not see documentation of the Preventative Health and Safety. LPA shared with the Licensee the importance of this course that includes Nutrition and Lead. There was a flyer given to the Licensee of where she can take the class at. Children files were missing the PM 286 the blue card LPA shared with the Licensee that the immunization record would need to be documented on the blue card and that it will be her responsibility to transfer the immunizations. Also, that blue copy paper can be used for the immunization record. LPA observed the Mandated Reporter Certificates for the Licensee and 1 staff. The Licensee Certificate date of completion is 08/23/2022. The Staff Certificate has expired, and date of competition was 01/30/2018. LPA shared with the Licensee that the Mandated Reporter Training Certificate is only valid for two years and would need to be taken. In the files there was No copies of the Immunization Record. LPA was able to review Staff 1 immunization on the phone. The Only documentation that was reviewed was the Influenza, TB. & TDAP there was no record of the MMR. There Licensee states is not providing IMS (Incidental Medical Services) services 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


Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WIENER FAMILY DAY CARE
FACILITY NUMBER: 191609128
VISIT DATE: 09/07/2022
NARRATIVE
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The following was thoroughly discussed with the Licensee:
All adults living and working in the home must be fingerprinted and cleared prior to entering the facility. The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

Licensee was reminded it is the Licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office within 24 hours of the Unusual Incident and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete General and Child Care Mandated Reporter 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. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/

Licensee shared with the LPA that she will not be taking any infants. Information was still shared with the Licensee.

LPA discussed the safe sleep regulations with licensee 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 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.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WIENER FAMILY DAY CARE
FACILITY NUMBER: 191609128
VISIT DATE: 09/07/2022
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Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome

The licensee was also recommended the following Safe Sleep Practices: always place infants on their backs for sleeping; use only a tight-fitting sheet on the crib or play yard mattress; do not hang any items from the crib or above the crib; keep all items, including blankets, out of the crib or play yard; pacifiers may be used as long as they do not have items attached to them; infants should not be swaddled or have any items covering them while sleeping; the temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold. Please note, these guidelines are recommendations for best practices only, until regulations are approved and

adopted.

Licensee was shared the following information during the visit:


Address was given to the Licensee for Community Care Licensing and should be written on the top portion of the form for the Notification of Parents Rights.
Fire Drills shall be documented every six Months Facility just opened back up August 29, 2022 from Vacation.
LPA advised the Licensee to remove the Emergency Disaster Plan out of her Personnel File and place alongside other documents
Frequently Asked Questions
Booklets on Safe Sleep for your Baby
Flyer for Preventative Health and Safety Class
Pin-20-24
Pin 22-02

The licensee was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.Type B deficiencies were cited during today’s visit 09/07/2022. Appeal rights were printed and discussed with the licensee. Exit Interview was conducted and a copy of the report was provided to licensee Gillian Wiener
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 09/07/2022 02:08 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: WIENER FAMILY DAY CARE
FACILITY NUMBER: 191609128

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022

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 [(observation) (interview) (record review, the licensee did not comply with the section cited above in [one] out of [two] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/21/2022
Plan of Correction
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Licensee stated that the she will have the Staff to complete the Mndated Reporter Training via email
Type B
Section Cited
CCR
102416.1(a)(6)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in onet] out of [one which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Licensee stated she will take the Preventative Health and Safety Class and email the certificate

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 EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 09/07/2022 02:08 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: WIENER FAMILY DAY CARE
FACILITY NUMBER: 191609128

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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) (interview) (record review)], the licensee did not comply with the section cited above in [two] out of [two] [which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2022
Plan of Correction
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Licensee stated that she will go to her Personal Doctor Doctor because she know she has had all of the immunizations and will have a blood test done. For thestaff will be the same.
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 EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
LIC809 (FAS) - (06/04)
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