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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402851
Report Date: 11/21/2019
Date Signed: 11/21/2019 01:03:31 PM

COMPREHENSIVE INSPECTION
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:ROBERSON FAMILY DAY CAREFACILITY NUMBER:
197402851
ADMINISTRATOR:ROBERSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3106317073
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY:14CENSUS: 2DATE:
11/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Paula Roberson_LicenseeTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted an unannounced annual random inspection at the facility listed above. At 9:30am LPA was met at the door by Licensee's niece who disappeared once Licensee arrived at the door. LPA met with Licensee, who guided analyst on a tour of the facility. There were two children present upon arrival. Current residents include Licensee's adult daughter and grandson.

This is a one-story home which consists of three bedrooms, one bathroom, kitchen, den/garage, front yard and backyard (fenced). Children's areas include the backyard and den. LPA observed a wall heater and stairs in the hallway accessible to children in care. The restroom was observed safe and sanitary. Per Licensee, areas off limits to children and parents include: all bedrooms, kitchen and the front yard. The Licensee provides all food for children in care.

All areas identified on the facility sketch that are accessible to children were inspected for safety, comfort, and cleanliness. There is telephone service during operating hours via a landline. There is central ventilation and heating.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed accessible to children in all three bedrooms. Sharp knives and tools were observed accessible in the kitchen as well the hallway closet.

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. Licensee states that there are no firearms stored in the home.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 7
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: ROBERSON FAMILY DAY CARE
FACILITY NUMBER: 197402851
VISIT DATE: 11/21/2019
NARRATIVE
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The valve on the required 2A 10BC fire extinguisher indicates fully charged and serviced as of October 2019 with an expiration date of 10/2022. Smoke detector inoperable at this time. Carbon monoxide detector tested and operable.

Children's area/den was observed clean and orderly. Appropriate sleeping arrangements including mats were observed.

Currently, children use the backyard for outdoor play time. The outdoor play area was observed fenced. LPA observed appropriate toys and other materials for children in the yard. The licensee states that supervision is always provided.

The Licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The Licensee's Pediatric First Aid and CPR expires November 2021. Basic first aid supplies were available, band-aids only.

Children’s records were reviewed, including emergency information and were found incomplete.

The Licensee provided proof of immunization against influenza, pertussis and measles. Licensee did not provide proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Licensee did not provide Disaster Drill log. LPA provided Licensee with a Facility Roster(LIC_9040).

Emergency Disaster Plan and Parent’s Rights Poster were not available, observed or posted.

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

LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SUID. LPA also consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Safe Sleep and Never Shake a Baby.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: ROBERSON FAMILY DAY CARE
FACILITY NUMBER: 197402851
VISIT DATE: 11/21/2019
NARRATIVE
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Licensee states that she is currently caring for infants. Licensee states that infants sleep with her in the bedroom. "They sleep with me, in the back room." LPA advised Licensee that regulations require infants to sleep in a standard crib or Pack-n-Play.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited must be cleared to protect the children’s health & safety. Because more than two Type A deficiencies are being cited, LPA conducted a comprehensive inspection.

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.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.

An exit interview was conducted with the Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights. Licensee stated she is very unorganized. LPA will be referring Licensee to Technical Analyst.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: ROBERSON FAMILY DAY CARE
FACILITY NUMBER: 197402851
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2019
Section Cited

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Operation of a Family Child Care Home: Fireplace/Heaters
(1) Fireplaces and open-face heaters shall be screened to prevent access to children...
This requirement has not been met as evidenced by:
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Based on LPA observations a wall heater was observed accessible to children in care as screen not made inaccessible and smoke detector observed inoperable.
This poses an immediate risk to the health and safety of children in care.
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Type A
11/27/2019
Section Cited

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Operation of a Family Child Care Home: Poisons/Hazardous Items/Detergents
Poisons detergents, cleaning compounds, medicines,...which could pose a danger to children shall be stored where they are inaccessible to children.
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This requirement has not been met as evidenced by: Based on LPA observation of sharp knives, screwdrivers, scissors, vitamins, medicines, hair products and bug spray found accessible in all three bedrooms, hallway as well as the kitchen. This poses an immediate risk to the health and safety of children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2019
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: ROBERSON FAMILY DAY CARE
FACILITY NUMBER: 197402851
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2019
Section Cited

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Mandated Reporter
Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider,...proof of completion.
The requirement was not met as evidenced by:
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Based on LPAs record review this requirement has not been met as evidenced by Licensee provided no proof of Mandated Reporter Certification.

This poses a potential risk to the health and safety of children in care.
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Type B
11/27/2019
Section Cited

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Disaster/Fire Drill Log
(1) The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
This requirement has not been met as evidenced by:
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Based on LPAs record review and observation of no drill log available.

This poses a potential risk to the health and safety of children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2019
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: ROBERSON FAMILY DAY CARE
FACILITY NUMBER: 197402851
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2019
Section Cited

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Posting Requirements
This requirement has not been met as evidenced by: Basesd on LPA record review and observations postings not observed and unavailable. This poses a potential risk to the health and safety of children in care.

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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: ROBERSON FAMILY DAY CARE
FACILITY NUMBER: 197402851
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/25/2019
Section Cited

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Operation of Family Child Care Home: Stairs
Where children are less than five years old are in care, stairs shall be fenced or barricaded.

THis requirement has not been met as evidenced by:
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Based on LPAs observation of interior stairs accessible to children in care, stairs from garage/den not barricaded.

This poses an immediate risk to the health and safety of children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2019
LIC809 (FAS) - (06/04)
Page: 7 of 7