192009334-7-7-2021-54-CC-AMOY-C4PRZW-20210707132836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192009334
Report Date: 07/07/2021
Date Signed: 07/07/2021 01:28:57 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:	GORDON FAMILY CHILD CARE		FACILITY NUMBER:	192009334
ADMINISTRATOR:	GORDON, DIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 635-5155
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY:	14	CENSUS: 6	DATE:	07/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Diana Gordon, Licensee		TIME COMPLETED:	01:30 PM

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On July 7, 2021 at 10:10am Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Required annual inspection to the above facility. Upon arrival LPA met with Diana Gordon, Licensee, who guided analyst on a tour of the facility. Also present during this inspection, is 17 year-old assistant. There were 6 children present, including 2 infants. A current children’s roster was available for review.

This is a single story home with 4 bedroom, 2 bathroom, living room, dining room, den, kitchen, and attached garage. There is also a fenced front yard and fenced backyard.

The accessible areas of the home include: living room, kitchen, den (where primary care is provided) off the kitchen area, 1 bathroom, and backyard.

Areas off limits include: 3 bedrooms, bathroom, garage and front yard. The doors to the bedrooms are kept locked during hours of operation.

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

All adults present in the home have obtained a criminal record clearance. Licensee states that there are no firearms stored in the home.
Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children stored in overhead cabinets in the kitchen. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary. `
The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/19/20, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements and cots and mats were observed.

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: GORDON FAMILY CHILD CARE	FACILITY NUMBER: 192009334
	VISIT DATE: 07/07/2021

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Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced and free of hazards. LPA observed that the outdoor yard has toys and other materials for children to play with.
The licensee is observed to be operating within the license capacity limitations.
The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 11/6/21. There are first aid supplies available.
The licensee has proof of immunization against influenza, pertussis, and measles.
LPA observed Licensee has proof of the Mandated Reporter AB 1207 Certificate completed on 3/23/20.
Children’s records were reviewed, including emergency information and were observed to be complete. Licensee has the LIC 9227 for Infants in care and the completed Infant sleep log for infant 12 months and under.
All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 06/07/21.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in a prominent location.

The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise children in their absence. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Licensee was reminded to use car seats and high chairs for their intended purpose. Car seats shall never be used for sleeping.

Licensee has 1 small dog, observed to be secured with a leash in the back yard. Licensee was advised to provided extra supervision if/when pets interacts with children in care

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: GORDON FAMILY CHILD CARE	FACILITY NUMBER: 192009334
	VISIT DATE: 07/07/2021

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Safe Sleep Regualtions:
LPA observed 3 play yards used for sleeping infants. Licensee was advised to sleep infant on their back, no loose fitting clothing, objects or articles in crib or play yard.
If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

LPA observed that licensee has a copy of PIN-20-24-CCP Safe Sleep Regulations LPA provided licensee with the Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA also consulted and explained Child Abuse Reporting, provided Complaint Hotline information, Never Shake a Baby, and Safe Sleeping practices.

Incidental Medical Services (IMS):
Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. 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.

LPA will provide licensee with link to sign up to receive regulations and quarterly updates from CDSS. Licensee states they are familiar with accessing forms and PINS online at: www.cdss.ca.gov.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Diana Gordon, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

End of Report

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GORDON FAMILY CHILD CARE	FACILITY NUMBER: 192009334
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/14/2021 Section Cited	1 2 3 4 5 6 7	102417-Operation of a Family Child Care Home: The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	LPA observed that the the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/19/20, as indicated on service tag. This poses a potential risk to the health abd safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC809 (FAS) - (06/04)

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