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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410174
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:55:51 PM


Document Has Been Signed on 09/28/2022 03:55 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:WOODS FAMILY CHILD CAREFACILITY NUMBER:
197410174
ADMINISTRATOR:WOODS, NICOLE M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 298-1170
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:14CENSUS: 5DATE:
09/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Nicole WoodsTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Doris Whitmore conducted an unannounced Inspection at the facility to ensure that health and safety standards are being met as required by regulations, statutes, and requirements governing California family childcare homes. Upon arrival, LPA met with Licensee, Nicole Woods and explained the purpose of the inspection. Present during this inspection was an adult assistant, who is fingerprint cleared and associated to the facility; 1 daycare child an infant was in care. LPA was guided on a tour of the home inside and outside by Licensee. Hours of Operation are Monday – Friday 6:00a.m. to 6:00p.m. At the time of the inspection there were 5 children.

The following was observed and discussed with the Licensee during the inspection
The home has undergone significant remodeling that is in the process of being completed. A blank copy of the Facility Sketch (LIC 999) is being provided to facility for completion and approval. Home is a 1 story dwelling that includes the following:
· 3 bedrooms (off limits)
· 1 bathroom (off limits).
· 1 kitchen (off limits)
· 1 living-room (off limits),
· 1 dining room (off limits)
· 1 sunroom (off limits) 1 front yard (off limits).
· 1 backyard (on limits), backyard also includes many shaded areas.
· 1 detached garage in the backyard that has been redesigned into the primary care area and includes a bathroom, as well as central heat and air conditioning (on limits).
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODS FAMILY CHILD CARE
FACILITY NUMBER: 197410174
VISIT DATE: 09/28/2022
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The following was also observed by LPA during the inspection
1. Home is neat and clean.
2. Heat& Air provided by ceiling vents.

3. Home is equipped with a fully charged fire extinguisher which is at least a 3-A4 BC.


4. Home is equipped with a working smoke alarm and a carbon monoxide detector.
5. Home has a working telephone.
6. All poisons are locked.
7. Hazardous materials are kept out of the reach of children (inaccessible).
8. According to the licensee, there are no weapons or firearms at the home. None were observed by LPA.
9. Outdoor play area is free from defects or dangerous conditions.
10. Outdoor play area is fenced in.
11. No bodies of water were observed during the inspection.
12. Toys and playthings are safe, clean, and age appropriate.
13. Licensee agrees that no baby walkers, bouncers, jumpers, and similar items will be used for children in care.
14. The home is equipped with a first aid kit

Per the licensee, there are no firearms or other dangerous weapons on premise.
The First Aid kit was observed and fully stocked. Licensee states there are no weapons or firearms of any kind in the home at this time. LPA did not observe any weapons during the visit.

The backyard is fenced The play areas (inside and outside) were inspected for safety. LPA observed play area outside to have sufficient enough toys. LPA observed 5 children files children files were completed. LPA observed two of the files for the staff the Licensee Mandated Reporter Training Certificate 09/30/21& 10/1/2021. First Aid & CPR 08/21/&08/23. At the time of the inspection LPA shared with the Licensee the importance of the Immunization record.At this time, the facility does not provide Incidental Medical Services - IMS.

The following was thoroughly discussed with the licensee


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.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODS FAMILY CHILD CARE
FACILITY NUMBER: 197410174
VISIT DATE: 09/28/2022
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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.htmIncidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders.

Licensee was reminded of their responsibility to report suspected child abuse. Mandatory Forms for the children’s files and provider’s files were discussed. Licensee was provided a LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home to ensure present and future compliance.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

LPA discussed with Licensee about Safe Sleep Safe Sleep Information and reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.



Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODS FAMILY CHILD CARE
FACILITY NUMBER: 197410174
VISIT DATE: 09/28/2022
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CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541.

Email Address: childcareadvocatesprogram@dss.ca.gov



Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
The following was discussed with the licensee:
All adults living and working in the home must be fingerprinted and cleared prior to entering the facility. The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.
· Entrance Checklist- Family Child Care Homes
· CARETOOL
· Safe Sleep Frequently Asked Questions
· Pin 20-24
· Infant Sleeping Plan (LIC 9227)

· Infant Sleep Observation Form

· Pin 20-24


· Forms Records to keep in your Family Child Care Home (LIC311D)
· Immunization Record
· Preventative Health & Safety including health including nutrition & lead & website www.caregistry.og & Phone Number (310) 452-3325 ext.219
· Pin 22-07 Guardian Webinar & Pin 22-06
· Pin22-02 Incidental Medical Services
Licensee informed that all persons employed or volunteering at a childcare facility or family day care must be immunized against the following: influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODS FAMILY CHILD CARE
FACILITY NUMBER: 197410174
VISIT DATE: 09/28/2022
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The licensee was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. The licensee was made aware that a licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

There were no deficiencies cited during today's visit. An exit interview was conducted, and a copy of this report was given to licensee Nicole Woods
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
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