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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006756
Report Date: 05/15/2019
Date Signed: 05/15/2019 10:52:59 AM

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:GUILLAUME FAMILY CHILD CAREFACILITY NUMBER:
192006756
ADMINISTRATOR:GUILLAUME, MARIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 413-2063
CITY:LOS ANGELESSTATE: CAZIP CODE:
90016
CAPACITY:14CENSUS: 0DATE:
05/15/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Marie & Jean GuillaumeTIME COMPLETED:
11:05 AM
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On 05/15/19. Licensing Program Analyst (LPA) Karren Starks made an unannounced visit for the purpose of conducting an 3yr Req. Inspection. LPA met with and toured the facility with Marie Guillaume also present at the time of inspection was the co-licensee Jean Guillaume. There were no children in a care at the time of visit. Per Mr. Guillaume they are currently caring for school-age children that come early in the morning and then go to school. This is a single story 2 bedroom, 1 bathroom home with kitchen, living room, dining room, family room and garage. The garage is used for storage only and no child care activities are conducted there. There is no pool, spa or other bodies of water on the premises. There are no additional adults, nor children residing in the home.

Main care is provided in the family room (located to the rear of the home). Children use the bathroom located at the end of the hallway (right side, near family room). Entry into the facility is made from the driveway to the back door entrance. Off limit areas include the home's 2 bedrooms, kitchen, living/dining room and the garage. The home was inspected inside and out 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. There is a wall heater in the corner of the room that is properly barricaded. LPA observed required postings.

Children play in the backyard. There is a concrete area for active play. There are no swings or slides.
Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There are age appropriate toys on the premises. The required fire extinguisher (4A60BC) and smoke/carbon monoxide detectors are in operable condition. There is a fireplace facade in the living room. CPR /First Aid expire 05/2021. The First Aid kit was observed and is complete. Incidental Medical Services (IMS) were discussed with the licensee's, it is not being provided at this time. Licensee's reminded anytime there are any renovations, reconstructions or construction made at the facility, the department must be notified. Emergency & Fire Drill log observed.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
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 3
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: GUILLAUME FAMILY CHILD CARE
FACILITY NUMBER: 192006756
VISIT DATE: 05/15/2019
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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.

The licensee is made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov



The licensee is informed of safe sleeping practices for infants to prevent S.I.D.S. (Suddent Infant Death Syndrome). The applicant is informed that infants are always to be placed on their backs for sleeping; to use tight-fitting sheets on the crib or play yard mattress; do not hang any items on or above the crib; to keep all items out of the crib/play yard; infants are not to be swaddled or have items covering them while sleeping; and 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. The Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Applicant is also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Licensee informed to review updates/regulations for 2016 on the department website: www.ccld.ca.gov . Licensee can also review the Fall/Winter Quarterly Updates 2015 and Spring 2016 Quarterly Update which includes information on: Assembly Bill (AB) 290 - for each new license issued, at least one director or teacher at a child care center or family child care home to have at least one hour of childhood nutrition training; AB 1207 - all child care employees must complete mandated reporter training beginning January 1, 2018,; AB 1387;
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: GUILLAUME FAMILY CHILD CARE
FACILITY NUMBER: 192006756
VISIT DATE: 05/15/2019
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Senate Bill (SB) 277 - require all children attending day care or school based programs to be immunized and: will eliminate personal/religious belief exemptions; SB 792 - requires all staff and volunteers to show proof of immunization against influenza, pertussis and measles, and TB clearance, beginning September 1, 2016.

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete 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. Website: www.mandatedreporterca.com

No deficiencies cited. Copy of report and Notice of Site visit issued.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
LIC809 (FAS) - (06/04)
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