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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403691
Report Date: 06/30/2022
Date Signed: 06/30/2022 11:20:58 AM


Document Has Been Signed on 06/30/2022 11:20 AM - 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:JOHNSON FAMILY DAY CAREFACILITY NUMBER:
197403691
ADMINISTRATOR:BETTY JOHNSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 292-9516
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:14CENSUS: 1DATE:
06/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Betty Johnson TIME COMPLETED:
11:15 AM
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On 6/30/2022 Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Betty Johnson.

Days and hours of operation are 6:00 a.m. to 6:00 p.m., Monday through Friday. Facility provides care and supervision to children ages 8 months old to 13 years old.

LPA toured the home inside and outside and a census was taken; 1 child was present during the inspection.

Current facility sketch reviewed, and Licensee confirmed that the den area is used for the day care. The kitchen area is occasionally used for the older children to eat. Licensee confirmed that napping and eating primarily occur in the den area. Families access the day care through the main entrance. Families sign in and are escorted to the den area. The bathroom, bathroom 2, that children use is located outside the den and kitchen area.

The following areas are currently OFF LIMITS: Living room, dining room, bedroom 1, bedroom 2 and bedroom 3, bathroom 1 and kitchen area. Doors will remain locked and closed during the hours of operations, making the area OFF LIMITS. LPA observed a detached garage that was observed to be locked making the areas in accessible to the children in care.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible and stored under the kitchen cabinet. Licensee confirmed that most cleaning supplies are kept in the laundry closet inside bathroom 2. LPA observed cleanings supplies on the top shelf inside the closet that is kept closed.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022
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: JOHNSON FAMILY DAY CARE
FACILITY NUMBER: 197403691
VISIT DATE: 06/30/2022
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adequate heating and ventilation for safety and comfort. LPA did observe three stairs in the den area that led to the kitchen. A safety gate was observed outside the den, making the kitchen in accessible. Safe toys and play equipment were observed. The home has a working telephone service and LPA confirmed the phone number is 323-292-9516. LPA confirmed a mobile number and working email with licensee.

Facility currently has one infant enrolled in the program. Licensee confirmed she has only 6 children enrolled in the program. LPA discussed Safe Sleep Regulations with licensee.

There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan will be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA observed a small Chihuahua outside and licensee confirmed the dog is maintained outside during the hours of operations. LPA reviewed current vaccine record for dog in the home.

LPA reviewed a sample of children’s files and observed files were complete. Licensee’s Mandated Reporter Training was reviewed and taken on 1/19/2022. Licensee’s pediatric CPR/First Aid was taken on 7/29/2021. LPA reviewed the LIC311D with licensee and provided a sample packet of all necessary forms. Licensee will ensure all files are up to date with all required forms.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
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: JOHNSON FAMILY DAY CARE
FACILITY NUMBER: 197403691
VISIT DATE: 06/30/2022
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All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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.


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 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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Betty Johnson.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC809 (FAS) - (06/04)
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