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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405358
Report Date: 09/13/2022
Date Signed: 09/13/2022 05:36:25 PM


Document Has Been Signed on 09/13/2022 05:36 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:CELESTINE FAMILY CHILD CAREFACILITY NUMBER:
197405358
ADMINISTRATOR:CELESTINE, CAROL A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 777-7737
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:14CENSUS: 1DATE:
09/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:28 PM
MET WITH:Carol Celestine, LicenseeTIME COMPLETED:
05:50 PM
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Licensing Program Analyst (LPA) Shandra Powell, conducted an unannounced Annual Required Inspection on 09/13/2022. LPA met with Carol Celestine, Licensee. During today's inspection, LPA observed 1 preschool child in attendance napping in living room.

LPA toured the inside and outside of the home. The home is a one story home with three bedrooms (off limits) LPA observed locks on each door (key lock and turn lock) the #3 bedroom entrance is off of #2 bedroom (must enter through bedroom #2 to enter into bedroom #3). The home has a living/dining room (main childcare area) one bathroom in hall (on limits) and kitchen (on limits). The home has a detached garage with bathroom within the garage. LPA observed a washer and dryer and two refrigerators and one deep freezer in garage. Per Licensee, no childcare is conducted in the garage. Licensee confirmed that the Living/Dining room is the primary childcare area. LPA observed age appropriate toys in the childcare area. LPA did not observe pool, spa, hot tub or other similar bodies of water on the premise. Per Licensee, there are no firearms, ammunition or weapons on the premise; none were observed by LPA. Licensee does not have any pets on the premises at this time.
LPA observe all required documents to be posted, posted in a prominent publicly accessible area at the facility; Facility License, PUB 394 Notification of Parents Rights and LIC 9148 Earthquake Preparedness Form.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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: CELESTINE FAMILY CHILD CARE
FACILITY NUMBER: 197405358
VISIT DATE: 09/13/2022
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LPA observed documents to be reviewed during inspection (LIC 610 A Emergency Disaster Plan, Disaster and Earthquake and Fire Drill was conducted 06/22. LIC 9040 Facility Roster. Roster completed with 5 children enrolled. LPA reminded Licensee emergency disaster drills are to be conducted once every month. Last drill earthquake drill conducted on 09/02/2022.

Licensee states no poisons are located in the home. Licensee states all medication, cleaning compounds and detergents are inaccessible to children in care.



The home is equipped with a fully charged fire extinguisher which is at least a 2A:10:BC LPA observed service tag dated 04/2022. LPA informed licensee to service the fire extinguisher every year and or buy a new one. The home is equipped with a functional carbon and smoke detector located in the hall which was tested during inspection. There is a first aid kit equipped in the home. Centralized heat and air conditioning along with fans are utilized as heating and cooling sources.

The home landline and doorbell were not working during inspection due to AT&T. Licensee is using cell phone for telephone use during this time.

The outdoor play is conducted in back yard (fenced). Per licensee children are not allowed in the front yard (not fenced). LPA advised Licensee, if children are transported to and from to have parent/authorized representative sign an agreement of consent and place in child's physical file. LPA also advised Licensee that a copy of the transporter's driver's license and insurance is to be placed on file at the facility. Licensee stated she does not drive anymore. The vehicle must have insurance at all times. Licensee ensures that children in care, are supervised at all times and is aware children shall not be left in parked vehicles.



Licensee and Assistant have completed Mandated Reporter training on 06/27/2022. LPA advised Licensee that Mandated Reporter training is to be renewed every two years and certificate of completion is to be placed in each employee's physical file.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
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: CELESTINE FAMILY CHILD CARE
FACILITY NUMBER: 197405358
VISIT DATE: 09/13/2022
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Furniture and equipment were inspected for cleanliness, age appropriateness & good repair. Napping & Bedding equipment were not inspected due to LPA did not observe any cribs nor playyards for infants during inspection. This is a potential health and safety risk to children in care.

A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700 and Emergency Information, LIC 995A/Parent's Rights, PM 286/Immunization (Blue) Card. All Files were complete.


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 if Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: CommonlyAsked 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.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
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: CELESTINE FAMILY CHILD CARE
FACILITY NUMBER: 197405358
VISIT DATE: 09/13/2022
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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




Requirements. 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.
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 is reminded that smoking is prohibited on the premises during hours of operation

An Exit interview was conducted. The copy of this report was provided to licensee with appeal rights.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 09/13/2022 05:36 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: CELESTINE FAMILY CHILD CARE
FACILITY NUMBER: 197405358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements:

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/15/2022
Plan of Correction
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Create a 15 sleeping log and send to LPA by POC of 09/15/2022 via email.
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: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
LIC809 (FAS) - (06/04)
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