192004244-7-3-2020-54-CC-ABAY-BR6MHM-20200703093744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192004244
Report Date: 06/24/2020
Date Signed: 07/03/2020 09:37:55 AM

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:	LIMBRICK FAMILY CHILD CARE		FACILITY NUMBER:	192004244
ADMINISTRATOR:	LIMBRICK, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 516-8437
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90061
CAPACITY:	14	CENSUS: 0	DATE:	06/24/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jacqueline Limbrick		TIME COMPLETED:	12:30 PM

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This was announced case management inspection conducted by Licensing Program Analyst (LPA) Alicia Bailey, for reopening family child care home. Due to COVID-19 and precautionary measures this case management inspection was conducted with Licensee Jacqueline Limbrick via a tele-inspection at 11:00am on 06/24/2020 by use of Facetime for the purpose of inspecting the facility reinstate to active status. This is a single story home, residing in facility are 2 Adults and 0 Children. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Operating hours are Monday thru Friday 6:00am to 6:00pm.

At 11:05am LPA Bailey was guided through a tour of the facility. The facility is currently inactive due to licensee remodeling facility, there are no children in care at this time, therefore LPA Bailey did not observe any children. LPA Bailey was taken on tour of the classroom, dining room and bathroom.

Areas used by the children were inspected as follows: classroom, dining room, and 1 bathrooms. Licensee states main care is provided in class room and dining room.

Areas off limits include: Kitchen, 3 bedroom, 1 bathroom, living room , Front yard and backyard

**Rooms that are off-limits need to be made inaccessible during operating hours** The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

At 11:10am LPA Bailey observed there are age appropriate toys and napping equipment on the premises. At 11:18 am LPA Bailey and Licensee Limbrick toured the kitchen. The counter tops were clean and free of clutter or standing food. The kitchen cabinets has safety lock and knives and medicine was in upper secure cabinet. Licensee stated will provide breakfast, lunch and snack.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia Bailey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

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: LIMBRICK FAMILY CHILD CARE	FACILITY NUMBER: 192004244
	VISIT DATE: 06/24/2020

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At 11:36PM LPA Bailey observed there are age appropriate toys and napping equipment on the premises. LPA Bailey observed first aid kit, fire extinguisher 2A10BC in the classroom .The smoke detectors, carbon monoxide was tested by Licensee Limbrick and viewed by LPA Bailey are in operable condition. Licensee PED F/A & CPR EXP. 02/18/21. AB1207 Licensee completed on: 02/18/19

LPA Bailey reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with licensee. *Infants should always sleep on their backs, mouths facing up*. LPA advised the applicant to sleep infants where they can always be directly supervised. LPA also advised against sleeping infants in a separate room.

There are NO weapons, firearms, swimming pool or spa observed on the premises. LPA Bailey did not observe any hazards or need for correction during the inspection

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements was reviewed and explained.

Fire and safety drills must be performed every six months and documented for review by the Department.
Smoking is prohibited in a family child care home, 24/7.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority.
During this visit, the LPA reviewed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) to the applicant. LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

Forms to be posted
LIC610A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia Bailey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

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: LIMBRICK FAMILY CHILD CARE	FACILITY NUMBER: 192004244
	VISIT DATE: 06/24/2020

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Facility Records:
LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse,
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).

Children’s records requirements:
LIC 700 Identification and Emergency Information, LIC 627 Consent For Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children In Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights.

Incidental Medical Services (IMS):
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

Based on the documents submitted and the inspection on this date, the facility is in compliance and grant the license to return to active status.

Exit interview was conducted with Licensee Limbrick via tele-inspection Facetime. This report along with a copy of the appeal rights will be sent to the Licensee Limbrick via email with a read receipt or confirmation of receipt of email, which will act as the Licensee’s signature. A copy of the signed report will also be sent to the Department.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia Bailey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

LIC809 (FAS) - (06/04)

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