<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418021
Report Date: 08/04/2023
Date Signed: 08/07/2023 09:54:38 AM


Document Has Been Signed on 08/07/2023 09:54 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:BONSEIGNEUR FAMILY CHILD CAREFACILITY NUMBER:
197418021
ADMINISTRATOR:BONSEIGNEUR, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 451-3900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:12CENSUS: 0DATE:
08/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jacqueline Bonseigneur, LicenseeTIME COMPLETED:
02:45 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 Analysts (LPA) Shandra Powell conducted an unannounced Required 1 year inspection. LPA arrived at the facility, identified self and met with Jacqueline Bonseigneur, Licensee, LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. This is a single dwelling home. Licensee stated herself, husband, one adult son and one minor son live in the home. Facility operation hours are Monday thru Fridays 2:00pm to 5:00pm.

Licensee stated only providing care for School Age Children at this time. (Licensee updated the LIC 279 to reflect time change and age group during inspection). Licensee guided analyst on a tour inside and outside of the home. There are no changes to the facility layout or to the off-limit areas of the family childcare home. Licensee stated the isolation area for ill children is in the living room of the home. Licensee provides snacks.

No children were present during inspection. During inspection LPA observed roster LIC9040 (2 children enrolled ), Emergency Disaster Plan LIC610A, and Fire Drill Log (last drill conducted July 2023.) LPA observed the Facility License and PUB 394 Notification of Parents Rights and Earthquake Preparedness LIC9148 posted in Recreation Room (converted garage) in back yard.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
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 7


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: BONSEIGNEUR FAMILY CHILD CARE
FACILITY NUMBER: 197418021
VISIT DATE: 08/04/2023
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
The home is a single dwelling home with 3 bedrooms, 2 bathrooms, open concept living/dining room with kitchen, service porch and detached garage. The off-limit areas of the home are bedrooms and bathroom #3 located in bedroom #3. All Off-limits rooms are made inaccessible to children in care by locks on doors. The living/dining room, kitchen/service porch, back yard and Recreation Room (1/4 bath room located in Rec. Room) are On-Limits to children in care. The home has a separated space in back yard with a jacuzzi which is locked with a iron gate. The jacuzzi is inaccessible to children in care. Per Licensee, no child care is conducted in the space where jacuzzi is located at anytime. Per licensee the primary childcare is being provided in the converted garage. LPA observed a pool table, TV, children chairs and toys during inspection. LPA observed a wall heater with screen and a fire place screened in dining/living area of 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 ceiling fans for a cooling source. Home has a working telephone (Landline). Hazardous materials in the kitchen and bathroom are inaccessible to children. Per Licensee stated no poisons are located at the home. According to the Licensee, there are no weapons or firearms at the home; None were observed by LPA. LPA observed one large fish tank with fish in the living room.



The home is equipped with a fully charged fire extinguisher which is at least a 2A:10BC. The home is also equipped with a working smoke detector and carbon monoxide detector located in hall and kitchen. LPA advised licensee to also place smoke/carbon detector in the Recreation Room. Licensee agreed. There is also a first aid kit equipped in the home. LPA observed current First Aid and CPR certificate for Licensee an expiration date of 06/2025. Licensee's Mandated Reporter Certification has expired on 06/28/2023. Licensee stated she has started the training on line and will complete and send to LPA via email on 08/07/2023.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: BONSEIGNEUR FAMILY CHILD CARE
FACILITY NUMBER: 197418021
VISIT DATE: 08/04/2023
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
Toys and playthings are safe, orderly and age-appropriate for the children.

Outside play for the children is conducted in the driveway behind gate and backyard of the home. The outdoor play area is fenced and free from defects or dangerous conditions. LPA observed one hot tub behind a locked gate during inspection. Licensee stated the hot tub has a top with locks when children are in care.

LPA completed Children's File Review during inspection. LPA reviewed 2 children files both children files were missing enrollment for school age children.



LPA reviewed Assistant file during inspection. File was complete however the MMR immunization's was not available. CPR expires 06/2025.

Licensee stated was not providing care to infants at this time.

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 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 is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: BONSEIGNEUR FAMILY CHILD CARE
FACILITY NUMBER: 197418021
VISIT DATE: 08/04/2023
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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Ms. Bonseigneur, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Notice of Site Visit - A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Jacqueline Bonseigneur.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7