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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418922
Report Date: 06/21/2022
Date Signed: 06/21/2022 02:21:48 PM


Document Has Been Signed on 06/21/2022 02:21 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
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: 11DATE:
06/21/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:TINA PHAMTIME COMPLETED:
02:30 PM
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On 6/21/2022 Licensing Program Analyst (LPA) Loyce Phillips, conducted an unannounced case management inspection to follow up on COVID-19 and provide technical assistance. LPA met with Licensee, Tina Pham, toured the facility and took a census. Upon arrival, there were 11 children and 1 Assistant present.

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

Face Mask- LPA discussed with Licensee the current mask mandates from Los Angeles County Departm ent of Public Health (LACDPH). As of 3/14/2022 masking indoors by all visitors, employees and children over 24 months of age is strongly recommended, but no longer required. Individual ECE providers, programs, and facilities may retain more restrictive policies. Licensee stated she prefers to continue with the mask mandates for indoors.

Arrival Procedures - Visual health checks are conducted on all children. Parents are asked to stagger doing drop-offs and pick-ups. LPA observed COVID-19 signs posted and hand sanitizer near sign-in sheet.

Activities- During table activities and meal time the children sit a table with a partition divider.

Napping- Children sleep six feet apart or head/toe orientation. The bedding is clean by the Licensee weekly.

Cleaning and Disinfecting - The facility is clean throughout the day. Toys and outdoor play equipment is clean and disinfect weekly. LPA advised When choosing cleaning products, use products approved by Environmental Protection Agency list.

809-C

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
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: 06/21/2022
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Reporting Requirements – LPA explained and reminded Licensee to report all COVID-19 positives cases to Department of Public Health. When reporting Unusual Incidents, call CCLD within 24 hours and submit Unusual Incident Report within 7 days.

LPA completed LIC 812-COVID-19 Initial Positive Checklist.

No deficiencies are being cited in accordance to Title22 of the California Code of Regulations and/or Health & Safety Codes.

An exit interview was conducted, a copy of this report and notice of site visit were provided to Licensee, Tina Pham

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC809 (FAS) - (06/04)
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