197414131-9-24-2019-30-CC-KSCT-BGBP4U-20190924105943

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414131
Report Date: 09/24/2019
Date Signed: 09/24/2019 11:00:05 AM

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:	WHITE FAMILY CHILD CARE		FACILITY NUMBER:	197414131
ADMINISTRATOR:	WHITE, BRENDA F.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 779-2342
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90044
CAPACITY:	12	CENSUS:	DATE:	09/24/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Brenda White		TIME COMPLETED:	11:15 AM

NARRATIVE

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Licensing Program Analyst (LPA), Keyona Scott, conducted a Case Management Inspection to the Family Child Care Home on 09/24/2019 to ensure Licensee received and understood the conditions of the Conditional Exemption Approval for ID# 7517245232. LPA met with Licensee, Brenda White, and toured the facility. Seven children (includes three infants) were present during today's inspection. Licensee's Assistant, Carolyn Greer, arrived at the facility at 10:00 AM.

Licensee informed LPA that she did receive the notice of Conditional Exemption Approval for ID# 7517245232 from Sacramento. Licensee stated that ID# 7517245232 also received the Conditional Exemption Approval notice. Licensee informed LPA that the conditions were reviewed by herself as well as with ID# 7517245232, in which they both understood the conditions of the Conditional Exemption Approval. Licensee informed LPA that ID# 7517245232 does not reside in the home, does not work at the Family Child Care Home on a regular basis and never worked at the Family Child Care Home full-time. Licensee states ID# 7517245232 is only used as a backup as needed.

LPA reviewed with Licensee the following conditions of the Conditional Exemption Approval for ID# 7517245232:

1) Does not handle client money.

2) Does not violate any licensing laws or regulations.

3) Does not engage in conduct that indicates that he/she may pose a risk to the health and safety of any individual who is or may be a client.

4) Does not fail to disclose a conviction even if it occurred before the exemption was granted.

5) Is not convicted of a subsequent crime.

Licensee was reminded that any additional negative information reported to Sacramento could result in denial of the current exemption.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

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: WHITE FAMILY CHILD CARE	FACILITY NUMBER: 197414131
	VISIT DATE: 09/24/2019

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The facility was operating in substantial compliance during this inspection on 09/24/2019. There were no Title 22 Deficiencies cited.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

An exit interview was conducted, and a copy of this report (LIC 809), Notice of Site Visit (LIC 9213), along with appeal rights were given to Licensee, Brenda White, whose signature confirms today's inspection and report.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

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: WHITE FAMILY CHILD CARE	FACILITY NUMBER: 197414131
	VISIT DATE: 09/24/2019

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Licensee states understands and accepts the conditions of the Conditional Exemption Approval for ID# 7517245232.

The following was thoroughly discussed with the licensee:
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

The Licensee was also recommended the following Safe Sleep Practices: always place infants on their backs for sleeping; use only a tight-fitting sheet on the crib or play yard mattress; do not hang any items from the crib or above the crib; keep all items, including blankets, out of the crib or play yard; pacifiers may be used as long as they do not have items attached to them; infants should not be swaddled or have any items covering them while sleeping; the temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold. Please note, these guidelines are recommendations for best practices only, until regulations are approved and adopted.

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.

Licensee was provided the following forms/brochures:

PUB 394: Notification of Parents' Rights Poster

Licensee was provided the following forms/brochures:

PIN 19-02-CCP: Safe Sleep Awareness Campaign
NIH Pub. No. 18-HD-5759: What Does A Safe Sleep Environment Look Like?
A Child Care Provider's Guide to Safe Sleep
Safe Sleep in Child Care

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

LIC809 (FAS) - (06/04)

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