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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418922
Report Date: 03/18/2022
Date Signed: 03/18/2022 09:53:35 AM


Document Has Been Signed on 03/18/2022 09:53 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:PHAM FAMILY CHILD CAREFACILITY NUMBER:
197418922
ADMINISTRATOR:PHAM, TINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 675-4403
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 0DATE:
03/18/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Tina PhamTIME COMPLETED:
10:00 AM
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On 3/18/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced Case Management – COVID-19 inspection to follow up on reported positive cases of COVID-19. Upon arrival, LPA met with Licensee, Tina Pham. LPA conducted a risk assessment and toured the inside and outside of the facility. LPA observed 0 children and 0 staff.

According to the Unusual Incident Report LIC 624B, on 01/12/2022 - 2 children tested positive for COVID-19. According to the Unusual Incident Report LIC 624B, on 01/14/2022- 1 child and Licensee tested positive for COVID-19.

Licensee stated that all children and staff who tested positive for COVID-19 isolated and were cleared to return to the facility on 1/24/2022 . See LIC 812 COVID-19 Follow Up for additional information about the positive COVID-19 cases.

During the inspection, LPA observed COVID-19 related signs/posters throughout the facility. At the entrance, LPA observed a sanitation area with hand sanitizer and touchless thermometer. LPA observed plexiglass shields on children's dining tables in the dining area. The children learning materials, books and toys are kept separate in cubbies with their names on it. Materials and toys are not shared. Cots are labeled and blankets are stored in individual cubbies.

During the visit LPA and Licensee discussed the following best practices:

Arrival Procedures - Children and staff must complete temperature checks and wellness checks every morning before entering the facility.

[CONTINUE ON PAGE 2]
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PHAM FAMILY CHILD CARE
FACILITY NUMBER: 197418922
VISIT DATE: 03/18/2022
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Face Masks - Face masks are not required indoors effective 3/12/2022, although the practice remains recommended. Face masks are not required outdoors. Licensee stated the facility continues to wear face masks indoors as a safety precaution.

Isolation area - Licensee stated a sick child is kept separate from other children in living room or dining room areas. Licensee or Assistant will stay with the child until the parent arrives.

Cleaning and Disinfecting - The outdoor play area and indoor are sanitized bi-weekly and cleaned daily.

PPE - The facility is fully equipped with PPE and cleaning supplies.

Reporting Requirements – LPA explained and reminded Licensee to report all COVID-19 positives cases to Department of Public Health. In addition, report all positives cases and closure of facility to Community Care Licensing. When reporting Unusual Incidents, call CCLD within 24 hours and submit Unusual Incident Report within 7 days.

No deficiencies are cited, per Title 22, Division 12, Chapter 3, of the California Code of Regulations.

An exit interview was conducted and a copy of this report (LIC 809) and Notice of Site Visit were provided to Licensee.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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