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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192003036
Report Date: 12/21/2020
Date Signed: 12/21/2020 04:48:41 PM

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:MEYERS FAMILY CHILD CAREFACILITY NUMBER:
192003036
ADMINISTRATOR:MEYERS, MARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 919-1296
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:14CENSUS: 5DATE:
12/21/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Mary MeyersTIME COMPLETED:
05:05 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Cynthia Reyes and Alanna Gontarek conducted a case management deficiencies inspection to the above facility on this date. LPAs Reyes and Gontarek identified themselves and discussed the purpose of the inspection. Due to COVID- 19 precautionary measures were taken during the entire inspection by LPAs Reyes and Gontarek, who wore appropriate personal protective equipment.
Licensee and her assistant Kelie who was also present during the inspection were also wearing appropriate personal protective equipment. Licensee gave LPAs a tour of the facility indoors and outdoors during this inspection.

LPAs observed the Trampoline that is located in the back yard and took photos. LPA requested a copy of the manufacture brochure with the information for appropriate use of the trampoline. Licensee stated she does not have a brochure but can request one if needed. LPAs took a photograph of manufacturer warranty on the outside of the trampoline. LPAs had licensee fill out a declaration regarding age appropriate use of the trampoline. LPAs consulted with the licensee regarding age appropriate use of it, as well as having a 100% out door supervision at all times.

LPAs informed the licensee of the citations on this date regarding fingerprint clearance and reporting requirements for withholding information that she has been married for 18 years while having her day care license and her husband Kent Robinson was never fingerprint cleared. A civil penalty will be assessed on this date. Licensee also did not disclose that she lives at another address in Los Angeles, and states she only resides at her husband's address on the weekends or after daycare hours.

Licensee stated she mailed out on this date a packet of documents (Updated application, declaration, and copies of bill statement) to the department.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
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 4
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: MEYERS FAMILY CHILD CARE
FACILITY NUMBER: 192003036
VISIT DATE: 12/21/2020
NARRATIVE
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Licensee stated she will not be using the front room for the daycare. Licensee stated she will submit an updated facility sketch regarding the inaccessibility of the front room via email to LPA Gontarek.

Upon receipt, Mary Myers, Licensee posted the Notice of Site Visit and the 809D page (documentation of deficiencies.) This report and the Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months.

The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent.

LPA provided Mary Meyers, Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

Exit interview conducted with Mary Meyers, Licensee, during which appeal rights were given and explained. The Licensee signature on this report acknowledges receipt of rights. Consultation was also conducted on this date.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: MEYERS FAMILY CHILD CARE
FACILITY NUMBER: 192003036
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2020
Section Cited

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Reporting Requirements: The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his
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or her 18th birthday. This requirement is not met as evidenced by Licensee's disclosure and Interviews, that the licensee was married in 2002 and did not report the change of household composition to the department. This poses a potential health and safety risk to the children in care.
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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: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: MEYERS FAMILY CHILD CARE
FACILITY NUMBER: 192003036
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/21/2020
Section Cited

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Criminal Record Clearance:
All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by
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Licensee was remarried in July 2002 and did not have her current husband fingerprint cleared. This poses an immediate health and safety risk to the children in care.
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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: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4