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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410656
Report Date: 06/09/2023
Date Signed: 06/12/2023 01:56:34 PM


Document Has Been Signed on 06/12/2023 01:56 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:ROBINSON FAMILY CHILD CAREFACILITY NUMBER:
197410656
ADMINISTRATOR:ROBINSON, MATTIE D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 759-0971
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:14CENSUS: 3DATE:
06/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mattie Robinson, LicenseeTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced annual inspection on 06/09/2023. A Risk Assessment for COVID-19 was completed before entry. LPA met with Mattie Robinson, Licensee. Licensee stated she does not have a Assistant at this time. A copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided to the licensee upon entry. Licensee stated the facility is operating Monday-Friday 6:00am-5:30pm. The licensee stated that she has 6 children enrolled, licensee was informed that an Assistant is needed if the facility has more than 8 children in care. Licensee agreed. During inspection an updated LIC279 was completed by Licensee. This is a one two story home. Licensee resides in the home alone. LPA observed 2 preschool children and one infant.

Licensee, guided analyst on a tour of the facility inside and outside. LPA observed Facility License Notification of Parents Rights (PUB 394) and Earthquake Preparedness (LIC9148) in frames. The documents were not posted on wall due to recent painting of the living room area per licensee.

LPA reviewed the Emergency Disaster Plan (LIC610A), Facility Roster (LIC 9040) (updated by licensee during inspection) and Disaster and Fire Drill Log (last earthquake drill was conducted in April 2023) during inspection.

Licensee stated the isolation area for ill children is located in the room (Office) which sits off of the living room.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2023
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: ROBINSON FAMILY CHILD CARE
FACILITY NUMBER: 197410656
VISIT DATE: 06/09/2023
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The home is a three bedroom, one bathroom home with detached converted garage and backyard. No childcare is being conducted in the detached converted garage. The licensee stated the detached converted garage is not used for childcare made inaccessible by locked door. The licensee indicates area for childcare is being conducted in the living room. All bedrooms are off limits to the children made inaccessible by locked doors. The Telephone Number was updated during inspection. The licensee uses central air and heating for a heating and cooling source. First Aid kit observed and complete in the facility. Furniture and equipment was inspected for age appropriateness and good repair. Licensee agrees that no baby walkers, bouncers, jumpers, and similar items will be used for children in child care.

The children eat, nap and play in the day care room (living room). LPA did not observed a child gate to the entrance of the kitchen however licensee uses kitchen as a walk through to take children to backyard for door play. Licensee will make cabinets and stove inaccessible to children in care with knob covers and safety latches. Hazardous materials in the kitchen and bathroom are inaccessible to children. LPA observed cleaning compounds on high shelf over washer and dryer during inspection. LPA reminded licensee when children bring food or drink items into the home during childcare hours they must be labeled and properly stored.

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. Furniture and equipment were inspected for age appropriateness and good repair. LPA observed age-appropriate toys and playthings for children to play with during inspection. LPA observed two plug outlets not covered with safety plug covers during inspection.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
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: ROBINSON FAMILY CHILD CARE
FACILITY NUMBER: 197410656
VISIT DATE: 06/09/2023
NARRATIVE
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The outdoor play area was inspected and gated. The outdoor play equipment was inspected for age appropriateness and good repair. No pools, spas, hot tubs, fish ponds, or similar bodies of waters observed during the inspection.


Licensee states that there is no firearms or other dangerous weapons currently in the home.

LPA observed a fire extinguisher, however has not been serviced within a year. LPA reminded licensee that the fire extinguisher must be serviced yearly and or a new fire extinguisher must be bought. Smoke/Carbon Monoxide detector was inspected and tested during inspection.

There is also a first aid kit equipped in the home. Licensee does not have a current CPR/First Aid Certification nor a current Mandated Reporter Certificate on file. This is a potential health and safety risk to children in care.


LPA reviewed children's file during today's inspection and observed two of the 3 children in care today had a complete file this is a potential Health and Safety Risk to children in care. The following LIC 700 (Identification and Emergency Information), LIC 627 (Consent for Emergency Medical Treatment), LIC 995A (Notification of Parents' Rights) and Immunization Records were observed for 3 children on the Roster during inspection.

LPA reviewed Licensee personnel file during inspection. LPA did not observe proof of immunization of measles, pertussis and Influenza during inspection.

LPA did not observe the 15 minute Infant Sleep Observation Log needed for infants while napping during inspection. This poses a potential health and safety risk to children in care.

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

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
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: ROBINSON FAMILY CHILD CARE
FACILITY NUMBER: 197410656
VISIT DATE: 06/09/2023
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The following was thoroughly discussed with Licensee:
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.
Incidental Medical Services (IMS):
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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm.
LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.
The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office within 24 hours of the Unusual Incident and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.
Licensee was 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

Exit interview was conducted with Licensee and appeal rights were given.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/12/2023 01:56 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: ROBINSON FAMILY CHILD CARE
FACILITY NUMBER: 197410656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2023
Plan of Correction
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Licensee will create a 15 min log and provide a copy to LPA via email by POC date 06/12/2023.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2023
Plan of Correction
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Licensee will complete the Mandated Reporter Training on line and submit a copy of certification to LPA via email by POC date of 06/13/2023
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: 06/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 06/12/2023 01:56 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: ROBINSON FAMILY CHILD CARE
FACILITY NUMBER: 197410656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2023
Plan of Correction
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Licensee will complete course and submit a current CPR/First Aid certification to LPA by POC date of 06/13/2023 via email.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

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: 06/12/2023
Plan of Correction
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Licensee will complete Child Care Home Orientation in person by July 30th 2023 and send a copy of the Orientation Certificate to LPA. Licensee will also send proof of Emergency contact for all children enrolled into facilty by POC date of 06/12/2023 to LPA via email.
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: 06/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2023
LIC809 (FAS) - (06/04)
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