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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414131
Report Date: 12/15/2021
Date Signed: 12/18/2023 10:15:50 AM


Document Has Been Signed on 12/18/2023 10:15 AM - 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:WHITE FAMILY CHILD CAREFACILITY NUMBER:
197414131
ADMINISTRATOR:WHITE, BRENDA F.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 779-2342
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:12CENSUS: 6DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:AssistantTIME COMPLETED:
05:20 PM
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Licensing Program Analyst (LPA) Keyona Scott, conducted an unannounced Annual Required Inspection on 12/15/2021. LPA met with Assistant (A1) at 11:23 AM. Licensee was not present at LPA's time of arrival. LPA observed five children in care, which includes one infant. Second infant was dropped off to facility at 12:20 PM. Licensee arrived to facility at 12:35 PM. All adults present, residing and working in the home are fingerprint cleared and associated to the facility.

LPA toured the inside and outside of the home. The home is a one story home with two bedrooms, two bathrooms, a living room, dining room, kitchen, childcare room, office space and detached garage. Per Licensee, no childcare is conducted in the detached garage. The childcare room is located to the rear of the home. Parents drop off and pickup children at the side gate to the rear of the home. LPA observed play yard cribs, age appropriate toys and books in primary care area. Both bedrooms at the front of the home are off-limits and inaccessible to children in care by safety gate at hallway entrance. Children utilize the bathroom at the end of the hallway. There is no fireplace in the home.

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. Home utilizes centralized heat and air conditioning system as a cooling and heating source. Home has a working telephone. Hazardous materials in the kitchen and bathroom are inaccessible to children. According to the Licensee, there are no weapons or firearms at the home; None were observed by LPA. There are no pets in the home. Page 1

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021
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 8


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: 12/15/2021
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The home is equipped with a fully charged fire extinguisher which is at least a 2A:10BC. The home is also equipped with at least one working smoke detector and carbon monoxide detector. There is also a first aid kit equipped in the home. LPA observed Licensee's and Assistant's Pediatric First Aid and CPR certificate with expiration dates of 12/11/2023. Licensee and Assistant's Mandated Reporter training expired 12/14/2021. LPA advised to complete and provide copy of Mandated Reporter training certificate by 01/18/2022. LPA observed required postings posted.

During inspection, LPA observed infant being placed in baby bouncer. LPA advised Licensee that baby bouncers are prohibited in licensed child care facilities. Licensee's Assistant removed infant from baby bouncer and removed baby bouncer from the child care area. Licensee agrees baby bouncer or other prohibited items will no longer be used for children in care and will remain inaccessible.

The outdoor play area is located in the backyard, which is fully fenced and free from defects or dangerous conditions. LPA observed a slide set, push cars and other age-appropriate playthings in the backyard play area. No pools, spas, hot tubs, fish ponds or similar bodies of water were observed during the inspection.

LPA observed current Fire Disaster Drill log. Licensee conducted last fire disaster drill in November 2021. LPA observed current Child Care Facility Roster of the children enrolled. There are currently seven children enrolled at the facility.

Licensee ensures that children in care, are supervised at all times and is aware children shall not be left in parked vehicles. Licensee was informed that car seats are used for transportation purposes only and are not used for sleeping children.

The facility operation hours are Monday through Friday, 7:00 AM to 6:00 PM.

The facility was operating in substantial compliance during today’s inspection on 12/15/2021. No deficiencies were cited. Page 2

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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: 12/15/2021
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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 if Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: CommonlyAsked Questions about Child Care Centers and the ADA available at: http://www.ada.gov/childqanda.htm

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Brenda White.


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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC809 (FAS) - (06/04)
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