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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192010090
Report Date: 05/04/2022
Date Signed: 05/04/2022 01:45:23 PM


Document Has Been Signed on 05/04/2022 01:45 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:MUIR & SIMPSON FAMILY CHILD CAREFACILITY NUMBER:
192010090
ADMINISTRATOR:JENNIFER MUIRFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 490-8062
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY:14CENSUS: 12DATE:
05/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Jennifer Muir - LicenseeTIME COMPLETED:
02:00 PM
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On 5/4/2022, Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced Annual Random/ I year required visit for Muir & Simpson Family Child Care Home. Present in the home was licensee Jennifer Muir and assistant Evelyn LeBlanc, supervising 12 day care children. The home is a single family, single story home. Day care operations are conducted in the lower den area of the home. Operational day and hours are 6:00 a.m. - 6:00 p.m. The home was inspected inside and out for Health and Safety compliance per Title 22.
LPA observed the following:
Care and supervision were observed
The homes capacity was within the scope of the license
Appropriate size fire extinguisher carbon and smoke detector present & operable.
Detergents, and knives were inaccessible, Toxins were locked and inaccessible.
The homes kitchen was inaccessible to children in care
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MUIR & SIMPSON FAMILY CHILD CARE
FACILITY NUMBER: 192010090
VISIT DATE: 05/04/2022
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Per licensee there was a firearm in the home, LPA observed a locked gun case that per co-licensee(not present) via telephone, the gun had no ammunition and has a firearm pin)
LPA was not able to physically observe the gun.
The home has a working telephone
LPA observed the homes parent notification board; the license and Parent’s Rights notification,were posted. The facility sketch, Emergency Disaster Plan, Lead Poison Awareness, Safe Sleep and California Safety Seat Law were not posted.
A first aid kit was observed containing the required supplies: scissors, tweezers, bandages, medical ointment and a thermometer. Licensee’s Pediatric CPR and First Aid Card expires 7/2023 No bodies of water were observed on the premises
Children records available and in good order.
Personal records were reviewed, LPA did not observe; immunization records for licensee and present assistant (1), licensee was advised to provide immunization records for; Pertussis, Measles and Influenza
Licensees Mandated Reporter certificate expires 8/2022. LPA did not observe certification for assistant (1)
A roster was readily available for review.
Due to Covid 19 children are signed in by licensee.
Licensee does not provide Individual Medical Services (IMS). IMS was discussed with licensee.
All adults in the home cleared a Criminal Background Clearance.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MUIR & SIMPSON FAMILY CHILD CARE
FACILITY NUMBER: 192010090
VISIT DATE: 05/04/2022
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Toys, equipment and materials available and in good order, licensee was advised to unstack some the toy and materials to reduce the risk of items falling on children.
Children napped on cots or play pens, that were found to be in good condition. Infant safe sleeping was discussed with licensee. Licensee cares for infants and was advised that best practice when caring for infants, individual bottles, cups and utensils should be labeled for each infant.
LPA reminded licensee that children are only to use car seats during transportation, and appropriate children’s feeding chairs shall only be used during mealtime.
Outdoor activities were conducted in the outdoors patio area, the area is fully gated, parents also enter through this area through the side gate. Resilient cushioning was observed under the climbing structure. LPA did not observe any hazardous conditions in this area.

To improve the quality and value of the new inspection process, a survey will 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 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.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MUIR & SIMPSON FAMILY CHILD CARE
FACILITY NUMBER: 192010090
VISIT DATE: 05/04/2022
NARRATIVE
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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://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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 report was reviewed with the licensee Jennifer Muir

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 05/04/2022 01:45 PM - It Cannot Be Edited

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: MUIR & SIMPSON FAMILY CHILD CARE
FACILITY NUMBER: 192010090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
159662(b)(1)

(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as Evelyn LeBlanc (assistant 1) did not provide current certification which poses a potential personal rights risk to persons in care.
POC Due Date: 05/13/2022
Plan of Correction
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Assistant (1) shall complete renewal of the Mandated Reporter traing course and provide a copy of the certificate to the local regional office no later than 5/13/2022
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 05/04/2022 01:45 PM - It Cannot Be Edited

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: MUIR & SIMPSON FAMILY CHILD CARE
FACILITY NUMBER: 192010090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as licensee -Jennifer Muir was not able to provide proof of MMR and (assistant) Evelyn LeBlanc was not able to provide proof of Measels, Pertussis or Influenza which poses a potential health, risk to persons in care.
POC Due Date: 05/27/2022
Plan of Correction
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Proof of immunization shall be provided to the Local Regional office no later than the due date of 5/27/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
LIC809 (FAS) - (06/04)
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