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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404759
Report Date: 06/16/2022
Date Signed: 06/16/2022 04:47:24 PM


Document Has Been Signed on 06/16/2022 04:47 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:LEE FAMILY CHILD CAREFACILITY NUMBER:
197404759
ADMINISTRATOR:LEE, BETTY C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 299-3557
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:14CENSUS: 9DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mashon Miller, AssistantTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Alicia Mooberry and Austin Estrada conducted a Required Annual Inspection to the a. LPA met with Mashon Miller, Licensee Assistant. Licensee, was not present upon arrival. LPA explained the purpose of the inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the hours of operation are Mon-Sat 24 hours. Licensee was reminded that a child cannot be in care for a duration of more than 24 hours. There were 9 napping children present. Also present were staff, Chamira Harris and Kaiawnata Young. All adults present have obtained background clearance. Individuals residing in the facility were discussed and noted. LPA discussed Overnight Care regulations and provided a copy. Per licensee there are no children currently receiving overnight care.

This is a single story, 2 bedroom/1 bath home with a separate unit in the backyard connected to the garage. The main daycare are is located in the separate unit in the backyard. LPAs inspected the unit which included a bathroom. The Daycare Unit is set up like a preschool.

The licensee has submitted an updated facility sketch

Off limit areas, per Licensee and facility sketch are: 2 bedrooms and bathroom. LPA observed doors to off limit bedrooms are closed.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged, serviced on 8/31/21. Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone.

The required documentation were posted in facility entrance which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.


-------------------Page 1 – Report Continues
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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 5


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: LEE FAMILY CHILD CARE
FACILITY NUMBER: 197404759
VISIT DATE: 06/16/2022
NARRATIVE
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The licensee provides food for children in care. Food is prepared in the kitchen of the home.

LPA observed that detergents, cleaning compounds are in the kitchen and in the Daycare room bathroom in locked cabinet inaccessible to children. Licensee states poisons stored in the locked storage room.

LPAs observed Isolation area is located in office, away from the other children. Per Licensee there are no firearms or weapons stored in the home. There are no pets.

Outdoor play area (fenced): Preschool age children use the open grassy area between the home and Daycare unit for outdoor play. School aged children use the side yard located next to the daycare unit. LPA observed that outdoor play areas have age appropriate toys and other materials for children. LPA observed a trampoline ( with safety netting) in the sideyard by daycare unit. Per licensee, only children age 6 and over are permitted access to trampoline following manufacturer guidelines. A gate preventing children under 6 years from accessing the trampoline was observed.

Infant Care: Licensee states they don't care for infant at the moment. LPA informed licensee of the new Safe sleep regulations, and provided including LIC 9227 Infant Sleep Plan. LPA provided information on PIN 20-24-CCP, 15-minute sleep check documentation for infants 0-24 months.

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)

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 Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

LPA observed that Files for Child #1, #2, #3, #5 and #7 had missing and/or not signed LIC 700. Child #2 is missing immunization record and Child #6 is missing LIC 627 this poses a potential risk to the health and safety of children in care. LPA also observed that the Staff #2 and #3 are missing proof of TB clearance, this poses a potential risk to the health and safety of children in care.

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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: LEE FAMILY CHILD CARE
FACILITY NUMBER: 197404759
VISIT DATE: 06/16/2022
NARRATIVE
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LPA observed that licensee is implementing COVID-19 precautions and procedures.

LPA provided licensee with PUB 394 with updated Regional Office information.

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 Centers 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.

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.

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/inspection-process.

Based on the LPA's records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

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


Exit interview conducted and report was reviewed with the Mashon Miller, Assistant. Appeal Rights were discussed and provided.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/16/2022 04:47 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: LEE FAMILY CHILD CARE
FACILITY NUMBER: 197404759

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on record reviews, the licensee did not comply with the section cited above in 5 out of 7 files reviewed were missing/or incomplete LIC 700 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/23/2022
Plan of Correction
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Per Assistant, the LIC 700 will be completed for Chid #1, #2, #3, #5, #7and a copy wil lbe sent to LPA by POC due date.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

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 in 1 out of 7 files reviewed did not have the immunizaton record which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/23/2022
Plan of Correction
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Per Assistant, the immunization record will be obtained and placed in file for Child #7, a copy will be emailed to LPA by POC due date.

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 CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 06/16/2022 04:47 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: LEE FAMILY CHILD CARE
FACILITY NUMBER: 197404759

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviewed, the licensee did not comply with the section cited above in 1 out of 7 records reviewed had not signed LIC 627 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/23/2022
Plan of Correction
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Per Assistant, the LIC 627 will be obtained and a copy provided to LPA by POC due date.
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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5