197402005-11-22-2022-54-CC-AESA-CLEUV5-20221122145434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402005
Report Date: 11/22/2022
Date Signed: 11/22/2022 02:54:54 PM

Document Has Been Signed on 11/22/2022 02:54 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	EVANS FAMILY CHILD CARE		FACILITY NUMBER:	197402005
ADMINISTRATOR:	EVANS, RUBY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 438-2452
CITY:	COMPTON	STATE: CA	ZIP CODE:	90221
CAPACITY:	12	CENSUS: 8	DATE:	11/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Licensee Ruby Evans		TIME COMPLETED:	03:10 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	On 11/22/22 at 11:15 AM Licensing Program Analysts (LPA) Austin Estrada and Susann Sanchez conducted an unannounced required 1 year inspection at the above facility. LPAs met with the Licensee Ruby Evans and informed her of the purpose for the visit. Licensee guided LPAs on a tour of the facility. There were eight children and three staff present when LPAs arrived. Criminal record clearance for all adults present was verified. Licensee provides care to children ages newborn to 12 years old and operation days/ hours are Monday through Friday 6:00 AM to 6:00 PM. This is a one story 3 bedroom, 2 bathrooms home with a activity room, classroom, living room, dining room area, kitchen, converted detached garage, and fenced backyard. Areas on limits to children are the activity room, classroom, bathroom located between the hallway and kitchen, and fenced backyard. Areas off limits to children are all bedrooms, bathroom located in the back hallway, living room, kitchen, and detached garage. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. Licensee also guided LPAs on tour of off limits areas. The following was observed and reviewed during this inspection: LPAs reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 11/1/22. Licensee had a copy of the Roster available during the inspection. There is an operable carbon monoxide detector and a smoke detector in the home. The 2A10BC Fire extinguisher in the kitchen indicated fully charged and were last serviced in 7/22. The home maintains telephone service (landline). Food is provided by Licensee. Licensee provided breakfast, lunch, afternoon snack, and dinner to children in care. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. The home is observed to be clean and orderly. There are toys and other age appropriate materials available for children. Sharp objects, detergents and cleaning compounds are kept in the off limits kitchen cabinet and are inaccessible to children in care. Sharp objects, such as knives are kept in a locked case in a cabinet in the kitchen inaccessible to children in care.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: EVANS FAMILY CHILD CARE	FACILITY NUMBER: 197402005
	VISIT DATE: 11/22/2022

NARRATIVE

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Cleaning products are kept in an upper cabinet in the kitchen inaccessible to children in care. Per Licensee there are no children who require medication. There is central AC/heating throughout the facility. LPAs observed a fireplace in the activity room inaccessible to children. LPAs observed age appropriate toys and materials in the activity room. Children use the restroom in the hallway between the office and kitchen. Per Licensee, children are supervised while playing outside. Per License, there are no poisons at the facility. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up in the classroom with adult supervision. Per Licensee, there are no firearms or weapons stored in the home. LPAs did not observe pools or spas, or other bodies of water.
Infant Care: Currently licensee cares for 2 infants. LPAs observed two cribs, one located in the classroom and one in the activity room. LPAs observed a changing table in the classroom. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPAs did not observe loose object, bumpers, objects hanging, or objects attached to the cribs. Each infant has their own crib and bedding. LPAs observed cots for children to sleep. Per Licensee, children sleep in the activity room. LPAs and licensee reviewed the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.
Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). Five out of eight children did not have LIC 700 on file at the time of inspection.
Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Licensee’s CPR/First Aid expires on 9/2/24. Mandated Reporter training certificate expires on 7/23/23. LPAs consulted Licensee regarding required documents that must be available for review for the children's records and personnel records.
During inspection, children present were observed to be treated with dignity and respect. Children were observed to be receiving safe, healthful, and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: EVANS FAMILY CHILD CARE	FACILITY NUMBER: 197402005
	VISIT DATE: 11/22/2022

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Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
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. LPAs discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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.
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.
Based on the LPA’s observations, interviews and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. The deficiencies being cited needs to be cleared to protect the children’s health & safety. Two type B violations are being cited for five out of eight children not having LIC 700 (Identification and Emergency Information) and for 3 out of 3 staff not having their immunization records on file completed at the time of inspection.

Exit interview conducted and report was reviewed with the Licensee Ruby Evans. A notice of site visit was given and must remain posted for 30 days.
Appeal rights were discussed and provided to the Licensee.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC809 (FAS) - (06/04)

Page: 3 of 8

Document Has Been Signed on 11/22/2022 02:54 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: EVANS FAMILY CHILD CARE	FACILITY NUMBER: 197402005
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation record review, the licensee did not comply with the section cited above in 3 out of 3 staff did not have immunization records on file during the insoection which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/22/2022
	Plan of Correction
1 2 3 4	Licensee will provide proof to LPA of immunization records for three staff via email.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 5 out of 8 children did not have LIC 700 on file at the time of inspection which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/06/2022
	Plan of Correction
1 2 3 4	Licensee will provide proof of completed LIC 700 to LPA via email.

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) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC809 (FAS) - (06/04)

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