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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418595
Report Date: 04/08/2021
Date Signed: 08/17/2021 03:46:25 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:WINDOM FAMILY CHILD CAREFACILITY NUMBER:
197418595
ADMINISTRATOR:WINDOM, JULIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 518-8925
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:14CENSUS: 3DATE:
04/08/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Julie WindomTIME COMPLETED:
07:13 PM
NARRATIVE
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"This is an Amended Report"

On 04/08/2021 Licensing Program Analyst (LPA) Laticia Thompson and Licensing Program Manager (LPM) Peter Flores met with Julie Windom to discuss a Case Management regarding deficiencies observed during a complaint investigation conducted on 03/18/2021. During the investigation of the complaint LPA inspected facility and observed the following deficiencies

· Off limits bathroom and bedrooms were not secured and locked to prevent children from accessing area.
· Hazardous materials were accessible to children in care as two security latches were inoperable on kitchen cabinets and drawers.
· Licensee was unable to provide rosters for children under care.
· Children files were incomplete and missing documents.
· A Sharp knife on sink counter accessible to children
· Scissor on table in children activity area
· Missing Mandated Reporter Training Certificate Completion

On 04/08/2021 LPA and LPM observed licensee adult son entering the facility and vacating the facility. Licensee son is not currently associated to the facility. LPA and LPM advised licensee son must complete a criminal background check and receive a clearance in order to visit the facility during operating hours.

LPA provided licensee with Covid-19 Posting to display throughout the facility. LPA advised licensee to display posting visibly in the entrance and throughout the facility so that parents, children, staff and any visitors can review per the televisit that was conducted with licensee on 09/10/20 via facetime.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
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 3
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: WINDOM FAMILY CHILD CARE
FACILITY NUMBER: 197418595
VISIT DATE: 04/08/2021
NARRATIVE
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Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be obtained as proof of parent’s receipts. LPA instructed licensee to post LIC 9213- Notice of Site Visit. Notice of Site Visit must be posted for 30 days. Failure to post required visit reports for 30 consecutive days will result in immediate civil penalty assessment of $100.

An exit interview was conducted, appeal rights and progressive civil penalties were explained, and a copy of this report was given to licensee by email. Licensee is instructed to reply to email acknowledging a copy was received. Licensee is also instructed to mail a report back to department a signature with 3 business days.

An advisory note is being issued to the licensee for the following:



The licensee is informed to ensure that all Mandated Reporter Certificate’s of completion shall be completed within 3 business days. Licensee will provide LPA Thompson with proof by my email or delivery to Regional Office on 04/14/2021.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: WINDOM FAMILY CHILD CARE
FACILITY NUMBER: 197418595
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/08/2021
Section Cited

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102417 Operation of a Family Child Care Home Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children (a)Storage areas for poisons...shall be locked This requirment was not met as evidence by
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Based on observation cleaning compounds were not stored and locked properlly, a sharp knife was left on the counter top and scissors were acceissble to children whic poses an immediate health and safety risk to children under care.
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Request Denied
Type B
04/08/2021
Section Cited

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Each child day care facility shall maintain a current roster of children..... provided care.. facility. The roster shall include the name, address...telephone number of the child's parent ... the name and telephone number... physician. This roster shall... to the licensing agency upon request. This requirment was not met as evidene by
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Based on record review licensee was unable to provide a roster of children which poses an potential health and safety risk to children under care.
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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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3