197413259-1-24-2024-30-CC-DWHE-CZT3HU-20240124171631

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197413259
Report Date: 01/24/2024
Date Signed: 01/24/2024 05:17:16 PM

Document Has Been Signed on 01/24/2024 05:17 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	JERRY FAMILY CHILD CARE		FACILITY NUMBER:	197413259
ADMINISTRATOR:	JERRY, CAROLYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 671-6528
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90302
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	01/24/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Carolyn Jerry		TIME COMPLETED:	05:15 PM

NARRATIVE

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On 01/24/2024 at 2:15, Licensing Program Analyst (LPA) Doris Whitmore conducted an Annual Inspection. LPA provided Licensee with the purpose of the visit and was granted access to the facility. LPA met with Carolyn Jerry, Licensee. LPA toured the inside and outside of the property at 2:15 with the Licensee. LPA observed the home to be clean, safe, orderly and well ventilated. There were 9 children present including 2 infants at the time of inspection. There was one assistant present at the time of the inspection. The operating hours are Monday thru Friday 6:00am to 6:00pm. Licensee stated that the hours have changed. LPA Whitmore informed Licensee that she will need to submit an updated application to reflect the hours that have been changed.

LPA observed the home to have a Living Room, Dining Room, Kitchen, 2 bedrooms, office, den and 2 bathrooms. The Licensee utilizes the den and 1 bedroom as the day-care. The rest of the home is inaccessible to the children. The den is used for napping for the smaller the children. The bedroom is used for eating for the older children, arts & crafts and homework. The smaller children eat at the table with toddler chairs. The backyard gate is open and used as the entrance for the parents.

LPA observed age appropriate toys and equipment for the children. Licensee states that there are no weapons in the home. Licensee reports that there are no pets in the home. The kitchen and bathroom areas were inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects. These items were made inaccessible to children. Kitchen/bathroom drawers were made inaccessible to children in care. LPA observed covers over the electrical outlets. The cleaning supplies are outside in the garage. The medication is stored on the top of the refrigerator. The knives are above the stove in a cabinet. LPA observed a small sunroom for children to play.

LPA observed operable smoke detectors and carbon monoxide detectors throughout the home which were tested during inspection. The home is equipped with 1 (2-A:10-B:C) Fire Extinguisher and First Aid kit which includes tweezers, thermometer, and band aids. Licensee stated that she has central air and heat for the

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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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Document Has Been Signed on 01/24/2024 05:17 PM - It Cannot Be Edited

Created By: Doris Whitmore On 01/24/2024 at 04:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JERRY FAMILY CHILD CARE	FACILITY NUMBER: 197413259
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [3] out of 2 (persons)which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/31/2024
	Plan of Correction
1 2 3 4	Licensee and Assistant will obtain Mandated Reporter Certificates and email to LPA.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) 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 is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in2] out of 2 (persons) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/31/2024
	Plan of Correction
1 2 3 4	Assistants to go to the doctor to get a copy of their immunization records. Licensee will email a copy to LPA

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 Starks

LICENSING EVALUATOR NAME:

Doris Whitmore

LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JERRY FAMILY CHILD CARE	FACILITY NUMBER: 197413259
	VISIT DATE: 01/24/2024

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home. LPA review a total of five children files. All of the children files had the required documentation in the files except LIC 9227. LPA Whitmore reviewed the staff files. Licensing Mandated Reporter Certificate expired 05/20/2021. The Assistant did not have any record of taking the Mandated Reporter Training Certificate. The First Aid and CPR was up-to-date LPA Whitmore shared the Entrance Checklist with the Licensee and the forms that the employees should have in their files. Two employees did not have any documentation to show their immunization record.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
Licensee was reminded that all Carolyn 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. LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [or facility representative] 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. is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. Licensee Carolyn 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.
During the exit interview, the LICENSEE ****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JERRY FAMILY CHILD CARE	FACILITY NUMBER: 197413259
	VISIT DATE: 01/24/2024

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 26 27 28 29 30 31 32	A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Carolyn. Please see the D P age for deficiencies of two Type B Violations.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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