192007146-6-8-2021-54-CC-ABAY-C3SVSW-20210608164212

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192007146
Report Date: 06/08/2021
Date Signed: 06/08/2021 04:44:14 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CARTER FAMILY CHILD CARE		FACILITY NUMBER:	192007146
ADMINISTRATOR:	CARTER, DEMETRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 637-2128
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY:	14	CENSUS: 4	DATE:	06/08/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Demetra Carter- Licensee		TIME COMPLETED:	12:55 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	This is an unannounced Case Management Inspection call conducted on 06/08/21 at 11:00 AM by Alicia Bailey Licensing Program Analyst (LPA). Due to COVID-19 and precautionary measures this case management inspection call was conducted via telephone with Licensee Demetra Carter. Licensee Carter has a total of (4) four children in care during today tele-inspection. Licensee were following staff-child ratios. On 05/25/2021, the Department received an unusual incident/injury report regarding a child sustaining an injury in the facility. Per the report, on at 9:20 am a child #1 fell hit their face just below the right eye on the bookshelf which resulted in a laceration under the eye. The incident happen while child #1 was playing with child # 2. child # 2 was holding on to child # 1 while trying to hit the back of child # 1 neck. When child # 1 pulled away from child # 2, child # 1 fell hitting his eye on the bookshelf. Licensee heard the incident and immediately started first aid to the injury. Licensee followed protocol called child # 1 parent who arrive to transport child # 1 to urgent care for further medical treatment. Child # 1 was treated ( receiving stitches to the laceration) and return to the facility the next day. Child #1 had no restrictions from the doctor. Licensee reviewed safety protocols while playing with the children. Child # 1 return to the doctor for a follow-up (7) seven days after the incident to have stitches remove. LPA visual inspected the area where the child fell and observed no tripping hazards or need for repair of the floor. LPA did not observe any need for repair of the bookshelf, nor observed sharp or broken edges.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia Bailey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

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: CARTER FAMILY CHILD CARE	FACILITY NUMBER: 192007146
	VISIT DATE: 06/08/2021

NARRATIVE

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Based on all information obtained on this date, and interview conducted, no follow-up is necessary regarding the incident. LPA determined that the injury was an accident. There were no violations that caused the incident/injury. Licensee followed the required protocol for reporting requirements" as the incident was reported to Child Care Licensing. No deficiencies were cited on this date.

Exit interview was conducted with Licensee Carter.This report along with a copy of the appeal rights will be sent to the Licensee Carter via email with a read receipt or confirmation of receipt of email, which will act as the Applicants/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: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC809 (FAS) - (06/04)

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