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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408239
Report Date: 06/07/2022
Date Signed: 06/07/2022 01:07:05 PM


Document Has Been Signed on 06/07/2022 01:07 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:CONNORS FAMILY CHILD CAREFACILITY NUMBER:
197408239
ADMINISTRATOR:STEPHANIE L. CONNORSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 978-8397
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 2DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Stephanie L. ConnorsTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Shandra Powell, conducted an unannounced Annual Required Inspection on 06/07/2022. LPA met with Licensee, Stephanie Connors, LPA observe 2 children in care. Per Licensee she is the only person residing in the home. All adults present, residing, working and/or volunteering in the home have a criminal record clearance or exemption.

LPA toured the inside and outside of the home. The home is a one story with three bedrooms, three bathrooms, living room, dining room and kitchen. The kitchen recently had construction completed in kitchen which changed the physical plant. Home has a detached garage on the premise and additional play room located in the back yard (permitted). The additional play room located in the back yard also has a bathroom (bathroom #3) is used for children activities only. Bedroom #2 in home is also used for children in care. Bedroom #1 and Bedroom #3 are off limits and are made inaccessible by closed and locked doors. Living room, Dining room and kitchen and bathroom #2 located in Master bedroom are also off limits. The children utilize the bathroom #1 at the back of the home off hallway and bathroom #3 located in detached playroom in back yard. Licensee stated children eat and nap in bedroom #2. Licensee has makeshift fire place in living room area.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Medications are locked in the Garage per licensee.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2022
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: CONNORS FAMILY CHILD CARE
FACILITY NUMBER: 197408239
VISIT DATE: 06/07/2022
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Home uses stand up fans and heaters for a heat and cooling source. Home has a working telephone. Hazardous materials in the kitchen and bathroom are inaccessible to children. According to the Licensee, there are no weapons or firearms at the home; none were observed by LPA. Licensee stated no pets are in the home.
The home is equipped with a fully charged fire extinguisher which is at least a 2A:10:BC LPA observed a current service tag dated May 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/smoke detector which was tested during inspection. There is a first aid kit equipped in the home. LPA observed Licensee Pediatric First Aid and CPR certificate with an expiration date of 07/2022. Licensee and staff completed Mandated Reporter Training on 02/2021. LPA advised Licensee Mandated Reporter Training is to be renewed every two years. LPA observed required postings posted (PUB 394 Notification of Parents Rights, LIC 9148 Earthquake Preparedness and Facility License). LPA observed documents to be reviewed during inspection (LIC 610 A Emergency Disaster Plan, Disaster and Fire Drills - last Fire Drill was conducted May 26th 2022, LIC 9040 Facility Roster. Roster completed with 12 children enrolled. LPA reminded Licensee emergency disaster drills are to be conducted at least once every month.

No pools, spas, hot tubs, fish ponds or similar bodies of water were observed during the inspection.

Furniture and equipment were inspected for cleanliness, age appropriateness & good repair. Napping & Bedding equipment were inspected for cleanliness & good repair.

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

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
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: CONNORS FAMILY CHILD CARE
FACILITY NUMBER: 197408239
VISIT DATE: 06/07/2022
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The Backyard is fully fenced. Licensee states children play in backyard and parents use the side gate to enter and exit facility. LPA inspected the backyard for safety, potential hazards. Toys and play equipment are age appropriate and in good repair.

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.

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.

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

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
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: CONNORS FAMILY CHILD CARE
FACILITY NUMBER: 197408239
VISIT DATE: 06/07/2022
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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.

The licensee appears to be within substantial compliance with Title 22 Regulatory 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.

Exit interview conducted and report was reviewed with the licensee. Appeal Rights were given to Stephanie Connors, Licensee.

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

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

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
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