197416526-9-23-2022-58-CC-DWHE-CJJ2BX-20220922171551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416526
Report Date: 09/22/2022
Date Signed: 09/23/2022 02:14:57 PM

Document Has Been Signed on 09/23/2022 02:14 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:	JOHNSON FAMILY CHILD CARE		FACILITY NUMBER:	197416526
ADMINISTRATOR:	JOHNSON, MARILYN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 839-2498
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90043
CAPACITY:	12	CENSUS: 7	DATE:	09/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:17 PM
MET WITH:	Marilyn Johnson		TIME COMPLETED:	05:12 PM

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	Licensing Program Analyst (LPA) Doris Whitmore conducted an unannounced annual random inspection to ensure the health and safety of the Child Care Home according to Department Regulations & Safety Codes. LPA met with licensee Marilyn Johnson and was guided on a tour inside and outside the home. All adults are present and residing in the home are fingerprint cleared and associated to the facility. At the time of the inspection was the licensee, and a Assistant in training. There was a total of 7 children in care and currently no infants. Operation Hours are Monday- Sunday 24 hrs. Meals that are provided to for the children are breakfast, a.m. snack lunch, p.m. snack, & dinner. The Main Day Care is in the Living Room. LPA observed a small blue table with chairs, Shape Bing bag toss, dolls, books, & arts crafts. The home is a one-story single-family house that includes: · 2 bedrooms · 1 Bathrooms · Kitchen · Living Room · Dining Room · Laundry Room · Front Yard · Back Yard Areas off limits include: · Bedroom · Office LPA inspected the home to ensure safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items do not pose a danger to children in care. 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.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 197416526
	VISIT DATE: 09/22/2022

NARRATIVE

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The backyard is fenced and there are no bodies of water. The required fire extinguisher (2 A10 BC) smoke detector carbon monoxide. The play areas (inside and outside) were inspected for safety. LPA observed play area outside to have sufficient enough toys. LPA observed 11 children files in two of the children files LPA observed a written immunization waiver written by the parent. LPA discussed with the Licensee that waivers are no longer being accepted and the parent would need to be a medical note or talk to the pediatrician. LPA observed two of the files the Licensee Mandated Reporter Training Certificate 03/12/2022. First Aid & CPR 01/24/2022 At the time of the inspection Licensee shared with the licensee the importance of having the required documentation for the Assistant.

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. 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 childcare licensing, and helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: (916) 654-1541. Email: childcareadvocatesprogram@dss.ca.gov

Licensee informed of mandated reporter training and advised since 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 (2) two years. Volunteers are encouraged but not required to take the training. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

Licensee informed Fire disaster drills are to be conducted at least once every 6 months and log must be kept. Applicant also informed children records, and facility roster must be kept for 3 years and advised all public reports must be kept for review. Forms and Regulations available at: www.ccl.cahwnet.gov. Licensee informed of appeal rights, must be in writing within 15 business days from date of receiving penalty assessment.

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 and follow up with a written Unusual Incident/Injury Report (LIC 624B).

Licensee 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, exer-saucers and any other items that fall into that category.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 197416526
	VISIT DATE: 09/22/2022

NARRATIVE

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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. Licensee was also reminded that only children eating may be in highchairs and that car seats are utilized only for transportation

The licensee was reminded it is their responsibility to know the regulations as well as anyone who assists in providing care. The licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. The licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

Update on Incidental Medical Services: 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
Incidental 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 Emptying an Ileostomy Bag.

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)

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 197416526
	VISIT DATE: 09/22/2022

NARRATIVE

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Infant Sleeping Plan (LIC 9227)
· Infant Sleep Observation Form
· Fire Drill Form to document Fire drills
· Pin 20-24
· Prohibited items in Family Child Care homes
· Forms Records to keep in your Family Child Care Home (LIC311D)
· L.A. County Public Health Customer Support for Blue Cards (323) 869-8080
· 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
· 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.

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 Marilyn Johnson

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

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