192004720-7-11-2023-54-CC-RVAA-CTMV37-20230711160416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192004720
Report Date: 07/11/2023
Date Signed: 07/11/2023 04:04:26 PM

Document Has Been Signed on 07/11/2023 04:04 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	KING FAMILY CHILD CARE		FACILITY NUMBER:	192004720
ADMINISTRATOR:	KING, BRENDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 291-5480
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY:	14	CENSUS: 1	DATE:	07/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Lottie Thornton, Licensee		TIME COMPLETED:	04:10 PM

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced annual required inspection at the above noted facility on July 11, 2023. LPA met with Licensee Lottie Thornton, who guided analyst on a tour of the facility. There was one daycare child (a 1 year old) when LPA arrived. Facility capacity is in compliance for a small Family Child Care Home. This is a two-story home that consists of three bedrooms, two bathrooms, living room, kitchen, dinning room, front yard (fenced) and back yard (fenced). Main care areas include living room, dinning room, bonus room, and front yard. Per Licensee, off limit areas include kitchen and upstairs bedrooms. Hours of operation are Monday-Friday from 6am to 6pm. Food is provided by Licensee.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE	FACILITY NUMBER: 192004720
	VISIT DATE: 07/11/2023

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LPAs reviewed required posted documentation located on the entrance door which included facility License, Publication (PUB) 394-Notification of Parental Rights and Licensing Form (LIC) 9148-Earthquake Preparedness form. Facility records were reviewed for LIC 9040-Facility Roster and LIC 610-Facility Disaster Plan. All documents were observed.

Smoke and carbon monoxide detectors located in the dinning room were tested and are operable. Fire extinguisher indicated fully charged and was last serviced on May of 2023. The home maintains telephone service via landline and cell phone. The home was observed to be clean and orderly. There are toys and other age-appropriate material available for children. LPAs observed that detergents, cleaning compounds and medication are stored in the kitchen and not accessible to children in care. There is a fire- place in the living room that is screened. Isolation area for sick children waiting to be picked up is in the bonus room, away from other children. Per Licensee, there are no firearms or weapons stored in the home.

The bathroom that children use is located in the bonus room adjacent to the kitchen, was observed to be clean and free of hazards.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE	FACILITY NUMBER: 192004720
	VISIT DATE: 07/11/2023

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Infant Care: Currently licensee has one infant enrolled. LPAs observed two Graco play yards for the younger infants, visible in the main care area. Napping equipment does not block entrances or exits. Standard play yard/bassinet mats were observed to be firm with tightly fitted sheets. LPAs did not observe loose/hanging objects, bumpers, or objects attached to the pacifiers. Per licensee wet or soiled sheets are changed as needed throughout the day. Each infant has their own crib and bedding. Bedding is washed once a week. Licensee states the following sleep supervision plan for infants: Infants nap in the main care area, where they are always supervised, infants are physically checked on every 15 minutes and time is documented. Licensee is implementing safe sleep regulations when infants are in care.

Currently, children are using the front yard for outdoor play. The outdoor play area was observed to be fenced. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.

Children’s records were reviewed for LIC 282-Affdavit Regarding Liability Insurance, Immunization Records, LIC 700-Identification and Emergency Information, LIC 627-Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months). All documents were observed.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE	FACILITY NUMBER: 192004720
	VISIT DATE: 07/11/2023

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Licensee records were reviewed for approved Pediatric First Aid and CPR certification, LIC 501: Personnel Record, LIC 508-Criminal Record Statement, Proof of Immunization against measles, pertussis, and influenza or influenza declination. TB clearance or risk assessment, LIC 9108-Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. All documents were observed.

During the inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

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

Based on the LPA’s observations and records review no deficiencies will be cited today 7/11/2023..

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE	FACILITY NUMBER: 192004720
	VISIT DATE: 07/11/2023

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To improve the quality and value of the new inspection process, a survey will be sent to 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/process.

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resouces/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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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