191803054-6-19-2023-30-CC-SPOL-CSXLVE-20230619090522

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191803054
Report Date: 06/16/2023
Date Signed: 06/19/2023 09:05:38 AM

Document Has Been Signed on 06/19/2023 09:05 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	GREER, CAROLYN FAMILY DAY CARE		FACILITY NUMBER:	191803054
ADMINISTRATOR:	CAROLYN GREER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 757-0552
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90044
CAPACITY:	14	CENSUS:	DATE:	06/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Carolyn Greer, Licensee		TIME COMPLETED:	01:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced annual inspection on 06/16/2023. A Risk Assessment for COVID-19 was completed. LPA met with Carolyn Greer, Licensee. A copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided to the licensee upon entry. Licensee stated the facility is operating 7days a week and 24hrs a day. The licensee stated that she has 11 children enrolled of which 2 are infants. LPA observed Assistant in back yard of home with 7 children at the initial start of the inspection. This is a two story home 7 bedrooms and 5 bathrooms. Per Licensee one other adult reside in the Family Child Care Home. All Adults present, residing and working in the home are fingerprint cleared and associated to the facility. Licensee, guided analyst on a tour of the facility inside and outside of the home. LPA observed Facility License, Notification of Parents Rights (PUB 394) and Earthquake Preparedness (LIC9148) posted on parent board in childcare room (family room). LPA reviewed the Emergency Disaster Plan (LIC610A), Facility Roster (LIC 9040) and Fire Drill Log (last Fire Drill conducted in February 2023) during inspection. Licensee stated the isolation area for ill children is located in the Bedroom #1.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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: GREER, CAROLYN FAMILY DAY CARE	FACILITY NUMBER: 191803054
	VISIT DATE: 06/16/2023

NARRATIVE

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The home was inspected for safety, comfort, cleanliness, telephone service (Land line), heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

The home is a two story home with 7 bedrooms (off limits) all bedrooms downstairs are made inaccessible by locked bedroom doors. 3 bathrooms off limits made inaccessible by closed doors. Living and Dining Room and Kitchen (off limits) Front yard (off limits) Back yard (on limits.) Day care is provided in the family room and den of the home.

The children eat, nap(cots) and play in the day care room areas. LPA observed a child gate to entrance of the kitchen to make the kitchen inaccessible during child care hours. LPA reminded licensee when children bring food or drink items into the home during childcare hours they must be labeled and properly stored.

All cleaning detergents and poisons are inaccessible to children and locked. The kitchen and bathroom were inspected for proper storage of detergents, cleaning compounds, medication, and sharp pointed objects. All items are made inaccessible to children in care.

Home utilizes central heat and ceiling fans for a cooling and heating source. Hazardous materials in the kitchen and bathrooms are inaccessible to children.

According to the Licensee, there are no weapons or firearms at the home; None were observed by LPA. LPA observed a fishtank in childcare area with gold fish.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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: GREER, CAROLYN FAMILY DAY CARE	FACILITY NUMBER: 191803054
	VISIT DATE: 06/16/2023

NARRATIVE

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LPA observed a fire extinguisher which is at least a 2A:10BC, Licensee will email a copy of the receipt to LPA showing receipt purchase within a year. LPA reminded licensee that the fire extinguisher must be serviced yearly and or a new fire extinguisher must be bought. Smoke/Carbon Monoxide detector was inspected and tested.

During inspection LPA observed a full complete First Aid Kit in the home. Current CPR/First Aid certification was available for review for licensee expires 12/11/2023. LPA observed a updated Mandated Reporter Training Certificate for licensee dated 12/15/2021.

LPA reviewed children's file during today's inspection and observed the following LIC 700 (Identification and Emergency Information), LIC 627 (Consent for Emergency Medical Treatment), LIC 995A (Notification of Parents' Rights). Files were complete.

LPA reviewed Licensee personnel file and Assistant file during inspection. Both files are complete.

The following was thoroughly discussed with Licensee:

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.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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: GREER, CAROLYN FAMILY DAY CARE	FACILITY NUMBER: 191803054
	VISIT DATE: 06/16/2023

NARRATIVE

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Incidental Medical Services (IMS):
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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. Licensee has subscribed to receive Important updates during inspection.

U.S. CONSUMER PRODUCT SAFETY COMMISSION FISHER PRICE INFANT EQUIPMENT RECALLS: PIN 20-19 advise licensee to print the Provider Information Notice to review.

During this inspection, LPA also provided the following documents about SIDS. 1) A Child Care Provider’s Guide to Safe Sleep by the American Academy of Pediatrics, 2) Safe Sleep for Your Baby by the U.S. Department of Health and Human Services.

LPA observe a complete 15 min sleep log for 2 infants during inspection.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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: GREER, CAROLYN FAMILY DAY CARE	FACILITY NUMBER: 191803054
	VISIT DATE: 06/16/2023

NARRATIVE

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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 CCLD office within 24 hours of the Unusual Incident and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.
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

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 experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process .

Exit interview conducted and report was reviewed with the Licensee. Report, Appeal Rights and Notice of Site Visit were given to Licensee. The Notice of Site Visit (LIC 9213) must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC809 (FAS) - (06/04)

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