197408694-8-15-2023-30-CC-JLAO-CUQQ3N-20230815114902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408694
Report Date: 07/12/2023
Date Signed: 08/15/2023 11:49:08 AM

Document Has Been Signed on 08/15/2023 11:49 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:	COUCHOIS FAMILY CHILD CARE		FACILITY NUMBER:	197408694
ADMINISTRATOR:	COUCHOIS, CATHLEEN C.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 828-9698
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	14	CENSUS: 13	DATE:	07/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cathleen "CC" Couchois		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/15/2023 Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection at 3309 Virginia Avenue, Santa Monica, CA 90404 and was greeted by licensee Cathleen “CC” Couchois. Present during today’s inspection was licensee with licensee’s husband and two assistants. The hours of operation are Monday – Friday 7:30 a.m. to 5:30 p.m. LPA toured the home inside and outside and a census was taken; 13 children with 4 adults providing care and supervision. Currently facility is available to take children ages 3 months to 4 years old. Facility is licensed for a Large Family child care license with a max capacity of 14 children. Licensee is not available for evening and/or overnight care. LPA observed no children under the age of 12 months of age. This is a single dwelling home which consists of 3 bedrooms, 2-bathroom, kitchen, family room and living room. Child care is conducted in the family room and one bedroom. Licensee confirmed the following areas as OFF LIMITS: bedroom 2 bedroom 3 with bathroom and kitchen. Licensee acknowledged that children may never enter these off-limit areas. The backyard is divided into section. One section of the gate which was made inaccessible to the children was observed to have a jacuzzi and one fountain with proper latch. Children do not have any access to the areas behind the fence. LPA observed the back yard to be fenced. Front yard and part of the back yard is used for day care space. During today’s inspections, LPA observed 13 children and 2 staff members providing care and supervision.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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: COUCHOIS FAMILY CHILD CARE	FACILITY NUMBER: 197408694
	VISIT DATE: 07/12/2023

NARRATIVE

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There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds are kept in the kitchen; designated as OFF LIMITS and observed kitchen to have a safety gate making the area inaccessible. Licensee confirmed that home is available to take in a child that might need medication, currently home does not have any child that needs medication. LPA reminded licensee to ensure that all necessary documents are kept on file and medication is always in its original packaging.

LPA observed licensee test the carbon monoxide and smoke detector in the home. LPA observed 1 working fire extinguisher in the closet in the hallway. Licensee confirmed that home provides meals and snacks. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted.

Adequate heating and ventilation for safety and comfort were observed in the space. Safe toys and play equipment were observed. The home has working telephone service and
LPA confirmed the phone number 310-828-9698.

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.
Capacity as specified on the license is being maintained during today’s inspection.

LPA reviewed licensee’s file and observed file was complete. LPA reviewed Mandated Reporter training and observed training was taken on 1/20/2023. Licensee’s CPR and First Certification was taken on 1/11/2023. Assistants’, Y. Fuerta and N. Valdovinos, CPR and First was taken on 1/11/2023. LPA reminded licensee the importance of making sure all vendors providing CPR and Pediatric CPR with First Aid need to be EMSA approved.

LPA discussed all necessary forms needed in each staff file and children’s file. LPA provided licensee with a current copy of the LIC 311D to use as a reference when auditing files. LPA reviewed 6 children’s files and observed files to be complete.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: COUCHOIS FAMILY CHILD CARE	FACILITY NUMBER: 197408694
	VISIT DATE: 07/12/2023

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Safe Sleep regulations were discussed due to program being available for infant care. Currently licensee does not have any children under the age of 12 months. 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. Infants up to 12 months of age are placed on their backs for sleeping. Individual Infant Sleeping Plan was discussed and LIC form was provided to licensee. LPA provided licensee with a sample sleeping log to use a reference.

Family Child Care Homes Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
Licensee, Cathellen Couchois, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee, Catheleen “CC” Couchois.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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