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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408924
Report Date: 05/22/2019
Date Signed: 05/22/2019 10:42:46 AM

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:BROOME FAMILY CHILD CAREFACILITY NUMBER:
197408924
ADMINISTRATOR:BRENDA BROOMEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 706-1443
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY:14CENSUS: 6DATE:
05/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Brenda BroomeTIME COMPLETED:
10:50 AM
NARRATIVE
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A RANDOM INSPECTION CONDUCTED IN ENGLISH
Licensing Program Analysts Ariel Cazares and Reiko Jones conducted an unannounced annual random site inspection to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPAs met with Licensee Brenda Broome and toured the facility. There were 6 children present at the time of arrival. One additional child arrived later during inspection. Individuals residing in the home are the licensee, spouse, and two adult children. Licensee’s operating hours are Monday-Friday 6:30am-5pm.

The home is a one story, 3-Bed, 2-Bath home. The following areas are used for day-care: Living Room, dining room, kitchen, 2 restrooms, activity room, and back yard. Off limit areas include: All bedrooms and detached garage.

Licensee has the Parent’s Rights poster and other appropriate forms posted on wall near the activity room. First Aid/CPR certificate are valid thru 07/28/2020 for licensee. Licensee's disaster drill log notes last drill conducted on 05/03/2019. Licensee has a working mobile telephone.

LPAs did not observe any accessible hazards or cleaning compounds. Fire extinguisher was last serviced on 3/5/18 and is due for a service. There is an operational smoke detector and carbon monoxide in the home. There is a First Aid Kit located in the closet in the activity room. There are adequate age appropriate toys, books, and games. LPAs observed a baby walker in the living room. LPAs reminded licensee that the item is prohibited. The item was removed immediately to an off-limits area. There are no firearms present on the premises as stated by licensee. LPA inspected the backyard and observed no hazards. The detached garage is maintained off-limits. There are no pools or spas, or other bodies of water. Currently there are no pets.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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 3
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: BROOME FAMILY CHILD CARE
FACILITY NUMBER: 197408924
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
CCR
102417(g)(1)
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The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
This requirement has not been met as evidenced by LPAs inspection of the fire extinguisher that showed it had not been serviced since 3/5/18. This poses a potential risk to the health and safety of children in care.
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Per licensee, she will service the fire extinguisher and submit proof to LPA of service by POC due date of 5/31/19.
Type B
05/22/2019
Section Cited
CCR
102417(g)(10)
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A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c).
This requirement has not been met as evidenced by LPAs observation of a baby walker in the facility. This poses a potential risk to the health and safety of children in care.
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The item was immediately removed during inspection. Correction was completed.
Type B
06/21/2019
Section Cited
HSC
1597.622(c)
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The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
This requirement has not been met as evidenced by LPAs review of staff records.
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Per licensee, she will obtain copies of the records and submit copies to LPA by POC due date 6/21/19.
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Staff #1 and Staff #2 are missing proof of measles and pertussis vaccines. This poses a potential risk to the health and safety of children in care.
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: BROOME FAMILY CHILD CARE
FACILITY NUMBER: 197408924
VISIT DATE: 05/22/2019
NARRATIVE
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Children's Roster is readily available and updated. Children’s Files were reviewed. Staff CPR/First aid certifications are valid. Staff #1 & 2 are missing proof of measles and pertussis vaccines.
The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.
· LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. A copy of Safe Sleep Concepts was provided.
· 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
· A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.

Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D.
LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov
Email Address:

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee Brenda Broome. A copy of this report and appeal rights discussed and explained.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3