192009334-6-28-2023-54-CC-AMOY-CT8S3N-20230628133124

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192009334
Report Date: 06/28/2023
Date Signed: 06/28/2023 01:31:34 PM

Document Has Been Signed on 06/28/2023 01:31 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
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:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Diana Gordon, Licensee		TIME COMPLETED:	01:45 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Required annual inspection to the above facility. Upon arrival LPA met with Diana Gordon, Licensee. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. The licensee provided tour of facility, There were nine (9) children present, including two (2) infants during inspection. Also present during this inspection, is Lucille Thomas, Assistant. A current children’s roster was available for review. The hours of operation are Monday-Friday 6am-6pm. All adults present have the required background clearance and are associated to the facility. Individuals residing in the home were discussed and noted.

This is a single story consisting of 4 bedrooms, 2 bathroom, living room, dining room, Family Room in rear (used as main daycare room), kitchen, and attached garage (converted to den). There is also a fenced front yard and fenced backyard.

The accessible areas of the home include: Family Room in rear of home (where primary care is provided), kitchen, bedroom 3 next to the family room, bathroom in the hallway, and enclosed backyard.

Areas off limits include: Bedroom 1 and 2, Master bedroom and bathroom, converted garage, front yard, shed in backyard, 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:

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 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 06/12/23, as indicated on service tag. Licensee was reminded to service the Fire Extinguisher yearly.

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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: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GORDON FAMILY CHILD CARE	FACILITY NUMBER: 192009334
	VISIT DATE: 06/28/2023

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LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted at entrance to Daycare Room, visible to parents of children in care. LPA reviewed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

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.

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.

Licensee states that there are no firearms stored in the home. There are no bodies of water on the premises.

The home maintains telephone service via cell phone line. The home is observed to be clean and orderly.

Per licensee poisons including insecticides are stored in the locked shed in the backyard inaccessible to children.

Currently, children are using the backyard for outdoor play. The outdoor play area was observed to be fenced with age appropriate plastic toys. LPA did not observe any objects that could be hazardous to children in care. The facility does not have a pool or similar bodies of water. LPA observed a small dog in the facility licensee, LPA discussed ensuring extra care when pets interact with children in care.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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. Infants sleep in Bedroom next to Family Room (Daycare area), with the door open and staff visually supervising.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. ---Page 2 Report Continures

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GORDON FAMILY CHILD CARE	FACILITY NUMBER: 192009334
	VISIT DATE: 06/28/2023

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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's 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)

Licensee and Staff records were reviewed and found to be completed

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries 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/inspection-process

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Based on the LPA's observations and records review there are no deficiencies cited today in accordance with California Title 22 Regulations.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee, Diana Gordon

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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