197417650-8-7-2019-30-CC-DMIA-BEU362-20190807175736

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197417650
Report Date: 08/07/2019
Date Signed: 08/07/2019 05:57:50 PM

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:	DAVIDOFF FAMILY CHILD CARE		FACILITY NUMBER:	197417650
ADMINISTRATOR:	DAVIDOFF, ESTHER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 549-9629
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90036
CAPACITY:	14	CENSUS: 5	DATE:	08/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Esther Davidoff, Licensee and Three Assistants		TIME COMPLETED:	05:20 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	On 8/7/2019, at 3:40pm Denise Miranda, Licensing Program Analyst (LPA) conducted an unannounced annual/random visit inspection to ensure the health & safety standards as required by regulations governing family child care homes are being met. Upon arrival, LPA met with licensee Esther Davidoff and informed the reason of the visit. Licensee guided analyst on a tour of the facility. LPA observed licensee and three assistants caring for 5 children. LPA verified that all adults present in the home have obtained criminal record clearances and are associated to the facility. The facility is two story duplex and the first floor of the duplex is licensed for child care. The home was inspected as follows: Kitchen, den, dining room, 3 bedrooms, 2-bathroom family room, front yard and backyard. The off-limits area includes: bedroom, master bedroom, office room and attached garage. Per licensee the detached garage is inaccessible to the children in care. LPA inspected the detached garage and observed that area been used for storage and park licensee’s car. At 3:55pm LPA observed a full charged Fire extinguisher size 2-A:10-B:C Fire Extinguisher full charged in the entrance of the house, first aid kit located at the kitchen area, working smoke and carbon monoxide detector, age appropriate toys. Telephone service, central heating, lighting and ventilation were evaluated and in good condition. Furniture and equipment were inspected for cleanliness, age appropriateness & good repair. Napping/Bedding equipment were inspected for cleanliness & good repair. Bathroom facility was inspected for inaccessibility of toxins and chemicals. Back yard play area was inspected for safety, potential hazards & inaccessibility to bodies of water. No bodies of water at the facility. LPA observed the licensee’s Infant/CPR 01/2021. LPA observed the last fire drill log conducted on 7/15/19. At 4:30pm LPA reviewed children’s file. Children’s file was completed. The licensee states that does not have weapons/firearms in the home and none observed by the LPA.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

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 5

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: DAVIDOFF FAMILY CHILD CARE	FACILITY NUMBER: 197417650
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/07/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/14/2019 Section Cited HSC 1596.8662(b)(2)	1 2 3 4 5 6 7	Mandated Reporting Certificate This requirement is not met as evidenced by observation and records review conducted during today’s inspection. The Director failed to ensure that the required mandated reporter assessment was completed and a certification obtained.	1 2 3 4 5 6 7	Licensee agrees to send a copy of Mandated Report Certification for licensee and license's the three licensee's assistants to LPA as proof of evidence by 08/14/19.
	8 9 10 11 12 13 14	and safety risk of children in care. This requirement is not met as evidenced by: LPA did not observe proof of Mandated Reporting Certification of licensee, licensee's and three licensee's assistant. This is a Type B violation and poses a potential risk to the health and safety to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

LIC809 (FAS) - (06/04)

Page: 5 of 5

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: DAVIDOFF FAMILY CHILD CARE	FACILITY NUMBER: 197417650
	VISIT DATE: 08/07/2019

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

LPA observed age appropriate toys. Per licensee no pets. LPA did not observe pets on the premises.

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. LPA provide brochures will information regarding SIDS and never shake a baby to prevent the shaken baby syndrome.

Licensee states at this time is not providing care and supervision - Incidental Medical Services (IMS): LPA disclosed the following information. – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license and immunization.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: DAVIDOFF FAMILY CHILD CARE	FACILITY NUMBER: 197417650
	VISIT DATE: 08/07/2019

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

Licensee was informed, Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(k)(1) Children shall not be left in parked vehicles. Civil penalty applies when a child is left unattended in a parked vehicle.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.
New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:
300 N. Continental Blvd., Suite 290-A
El Segundo, CA 90245
Also, LPA discussed with the licensee the following: A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. The fire extinguisher type 2-A:10-B:C must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check, and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: DAVIDOFF FAMILY CHILD CARE	FACILITY NUMBER: 197417650
	VISIT DATE: 08/07/2019

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

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Licensee informed fire drill to be completed every 6 month and to keep a log and to ensure records for staff and children as well as a roster are kept for 3 years.

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

LPA reminded co-licensee every two year to take the Mandated Reporter training: www.mandatedreporterca.com

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 child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov

During this inspection, LPA also provided the following documents about: 1) A Safe Infant Environment Sleeping, 2) Never ever shake a Baby (California Department of Social Services), 3) California School Immunization Record form CDPH286, 4) LIC311D Forms/Records to Keep in your Family Child Care Home 5) Prohibited items in Family Child Care Homes H&S 1596.846(b) &) Health 6) Pillow and babies don ‘t mix, 7) Keep me safe 8) Never shake a baby (Department of Social Services), 9 California Law will keep your child safe in the car (California Department Public Health).

The facility was found not to be in substantial compliance per Title 22 Regulations. A copy of report, a Notice of Site Visit and were issued and explained to the Licensee.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

LIC809 (FAS) - (06/04)

Page: 4 of 5