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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420038
Report Date: 07/15/2024
Date Signed: 07/15/2024 05:07:30 PM

Document Has Been Signed on 07/15/2024 05:07 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MATHEU FAMILY CHILD CAREFACILITY NUMBER:
197420038
ADMINISTRATOR/
DIRECTOR:		MATHEU, SHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 424-7001
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 24DATE:
07/15/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Sheryl Matheu, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:35 PM
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On 07/15/2024 at 1:30 PM, Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 3 Year inspection to the above facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Sheryl Matheu, who granted entry to facility. Also present were A1 and A2, Licensee’s Assistants. Adults in the home were discussed and all have criminal record clearance. There were24 daycare children, which includes five infants, present during today’s inspection. Facility is currently operating over capacity. LPA discussed this with Licensee, and Licensee states it was her understanding that due to COVID-19 family child care homes were able to operate with up to 20 children. LPA notified Licensee that this is not accurate information and any COVID-19 Waiver is no longer applicable and was never allowed to operate over the capacity of 14. Licensee states that there are currently 17 children enrolled based off of Facility Roster but more attending for the Summer. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are 7:30 AM to 6:00 PM Monday thru Friday. Required postings were observed at time of inspection. Disaster drill log was not available during today’s inspection, License states they conduct drills regularly but did not have a log available at time of inspection. LPA discussed requirement to log drills. LIC 126 was provided.

This is a single-story home which consists of two bedrooms and one bathroom, Kitchen, Living Room, and Dining Room. Areas used by the children include the Living Room (located upon entry), Dining Room (located next to Living Room), Bathroom 1 (located to the left of Living Room), Bedroom 1 (located to the left of Bathroom 1), and Kitchen (located to the rear of the home). Per Licensee, areas off limits to children and parents include Bedroom 2. Per Licensee, off limit areas are locked during operating hours, LPA observed lock available though door was open at time of inspection.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed ceiling fans, portable AC unit, and open windows allowing for ventilation through out the home. There is a working telephone maintained in the home. At 1:35 PM LPA observed Living Room and observed 16 children laying
Report Continues - Page 1 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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 15
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038
VISIT DATE: 07/15/2024
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down on blue cots with two children in cribs sleeping on the corners. LPA observed a variety of age appropriate toys, free of loose and sharp parts available in Living Room. At 1:37 PM, LPA observed three infants in Dining Room one sleeping on a bouncey chair and A1 and A2 each carrying an infant at time of inspection. LPA observed child size table and chairs available in Dining Room and cubbies for children's belongings. At 1:40 PM, LPA observed Bathroom 1 to have general area safety and sanitation, adequate supplies, and operable equipment at time of inspection. At 1:42 PM, LPA observed Bedroom 1 to have three cribs, with one child sleeping in a crib, one infant sleeping in a crib, and additional child asleep on a Doona car seat stroller at time of inspection. LPA notified Licensee to move all sleeping children in appropriate sleep equipment. LPA observed infant sleeping on bouncey chair and child asleep on Doona car seat stroller moved to appropriate sleeping equipment at time of inspection. At 1:43 PM, LPA observed Kitchen to be free of clutter at time of inspection. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Licensee states she only has one knife, which LPA observed stored on high shelf in a cabinet in the Kitchen. LPA observed cleaning solutions stored on high shelf in laundry closet at time of inspection. Licensee states that there are no poisons in the home used to kill vermin/bugs present at the facility at time of inspection. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the age, size, and abilities of children in care.

Per Licensee, the children will have access to backyard which is accessible through back door in Kitchen. At 1:50 PM, LPA observed backyard has grass with areas of turf covering and adequate perimeter fencing through-out the yard. LPA observed a variety of age appropriate outside toys free of loose and sharp parts available for the children such as plastic ride along cars, small plastic play structure, and plastic play houses. LPA observed a large trampoline in corner of backyard with safety netting that has been maintained at time of inspection. LPA observed a large sand pit to the right of backyard with a variety of sand toys available for children. LPA observed all trees, shrubs, and plants are maintained at time of inspection.

Per Licensee, they provide food for children in care and also allow children to bring food. LPA discussed that any food brought from home must be clearly labeled with child's name. Isolation area for sick children is in area of home currently not being used.

LPA did not observe any pets at time of inspection and Licensee confirms she has no pets. Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or firearms/weapons at time of inspection.
Report Continues - Page 2 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 15
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038
VISIT DATE: 07/15/2024
NARRATIVE
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At 1:53 PM LPA observed the valve on the required 2A10BC fire extinguisher indicates fully charged with proof of purchase receipt dated 10/19/2022. LPA tested dual smoke and carbon monoxide detector and observed to be operable at time of inspection.

At 2:30 PM, LPA conducted record review of children and staff files present at time of inspection. LPA observed, A1 and A2 has current Pediatric First Aid and CPR valid until 01/27/2025. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection for Licensee and all staff. Licensee and Assistants have not taken the required AB1207 Mandated Reporter Training at time of inspection, Licensee states she was not aware of requirement. Children records were reviewed for required documents, and LPA observed 3 of 9 children/infants records to not have immunization records in file at time of inspection.

The following were discussed:
Rooms that are off-limits need to be made inaccessible during operating hours.

NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov.



Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

Report Continues - Page 3 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
Page: 3 of 15
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038
VISIT DATE: 07/15/2024
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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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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/.



MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

Based on this information the following deficiencies on the LIC 809 D are being cited today, 07/15/2024.
Report Continues - Page 4 of 5

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
Page: 4 of 15
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038
VISIT DATE: 07/15/2024
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LPA Chicote informed Licensee Sheryl Matheu that this report dated 07/15/2024 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Chicote informed the Licensee to provide a copy of this licensing report dated 07/15/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Licensee, Sheryl Matheu.


Report Ends - Page 5 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
Page: 5 of 15
Document Has Been Signed on 07/15/2024 05:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/15/2024 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(a)
Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation and interview, Licensee did not meet above requirement. LPA observed total census of 24 children at time of inspection which exceeds the 14 by 10. This poses an immediate health, safety, and personal rights risk to children in care.
POC Due Date: 07/16/2024
Plan of Correction
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2
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Licensee states she has called parents/Authorized Representatives to begin picking up children. LPA observed eight children picked up at time of inspection. LPA provided capacity worksheet to Licensee at time of inspection and clarified misinformation.
Type A
Section Cited
CCR
102416.5(d)(1)
102416.5 Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
(1) Twelve children, no more than four of whom may be infants; or
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
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Based on LPA observation and interview, Licensee did not meet above requirement. LPA observed five infants present at time of inspection, which exceeds maximum number of infants allowed to be present at the facility. This poses an immediate health, safety, and personal rights risk to children in care.
POC Due Date: 07/16/2024
Plan of Correction
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2
3
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LPA observed two infants picked up at time of inspection, which would leave total census of infants to be three infants. Clearing deficiency on this date.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 6 of 15
Document Has Been Signed on 07/15/2024 05:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/15/2024 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on LPA record review and interview, Licensee did not meet above requirement. LPA observed fire extinguisher hanging in Kitchen with proof of purchase dated 10/19/2022. Licensee confirms this is her only fire extinguisher. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
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Licensee states she will buy a new fire extinguisher and provide proof of purchase receipt via email to LPA by POC date.
Section Cited
Deficient Practice Statement
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3
4
POC Due Date:
Plan of Correction
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2
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4
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 7 of 15
Document Has Been Signed on 07/15/2024 05:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/15/2024 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on LPA record review and interview, Licensee did not meet above requirement. Licensee states they conduct drills regularly but admits to not have it logged at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
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Licensee states she will conduct a drill and provide proof to LPA via email by POC date.

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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 8 of 15
Document Has Been Signed on 07/15/2024 05:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/15/2024 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, Licensee did not meet above requirement. LPA observed a saucer chair which fits into the category of baby walkers present at the facility at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
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2
3
4
Licensee states she will dispose of saucer chair and provide photo proof to LPA via email by POC date.
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA observation, Licensee did not meet above requirement. LPA observed C2 sleeping on bouncey chair at time of inspection and C2 was moved upon LPA direction. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
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2
3
4
LPA observed Licensee move C2 to nap equipment at time of inspection. Clearing deficiency during inspection.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 9 of 15
Document Has Been Signed on 07/15/2024 05:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/15/2024 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation and interview, Licensee did not meet above requirement. Licensee states she was unaware of requirement to log infants' sleep observations at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
1
2
3
4
Licensee states she will begin logging infant up to 12 months sleep and provide proof to LPA via email by POC date.
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, Licensee did not meet above requirement. LPA observed Bedroom 1, where three cribs and at least one infant was sleeping to be closed at time of inspection. LPA opened door in order to gain access to Bedroom 1. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 07/16/2024
Plan of Correction
1
2
3
4
Licensee states LPA observed door to remain open during rest of inspection. Clearing deficiency on this date.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 10 of 15
Document Has Been Signed on 07/15/2024 05:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/15/2024 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, Licensee did not meet above requirement on 3 of 3 files reviewed. Licensee states she was not aware of training requirement at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
1
2
3
4
Licensee states they will take training and provide proof of completion to LPA by POC date via email.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA record review, Licensee did not meet above requirement. LPA did not observe immunization records for 3 of 9 children's files reviews reviewed. LIC 857 was provided at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
1
2
3
4
Licensee states they will obtain immunization records, which she believes some are in her email, by POC date to LPA via email.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 11 of 15
Document Has Been Signed on 07/15/2024 05:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/15/2024 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MATHEU FAMILY CHILD CARE
FACILITY NUMBER: 197420038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA record review, Licensee did not meet above requirement. LPA reviewed C3's (DOB: 03/14/2024) record and did not observe LIC 9227 filled out at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
1
2
3
4
Licensee states she will have child's Autorized Representative fill out form and provide to LPA by POC date via email. Licensee states today is C3's first day.
Type B
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, Licensee did not meet above requirement. LPA observed C1 sleeping in Doona car seat/stroller at time of inspection. In addition, LPA observed floor/wall heater that is barricaded with chicken wire which LPA observed to have sharp edges poking out at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/15/2024
Plan of Correction
1
2
3
4
Licensee states she will provide photo of wall heater cover being taped to cover sharp edges to LPA by POC date via email. LPA observed C1 be moved out of car seat and placed in a appropriate sleep equipment at time of inspection.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 12 of 15