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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493354
Report Date: 10/29/2020
Date Signed: 10/29/2020 04:13:36 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:KAUFMAN FAMILY CHILD CAREFACILITY NUMBER:
197493354
ADMINISTRATOR:KAUFMAN, ANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 822-6181
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:12CENSUS: 5DATE:
10/29/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Anita Kaufman, LicenseeTIME COMPLETED:
05:00 PM
NARRATIVE
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On 10/29/2020 at 3:15pm, LPA Adrian Risher conducted a Case management deficiencies tele-visit inspection for the purposes of citing for the deficiencies that were observed on 08/27/2020 and 09/24/2020. LPA informed the Licensee the purpose of the inspection. During today’s inspection there are 5 children in care. Licensee stated that she would call LPA back because she was driving.
During the complaint investigation # 30-CC-20200824160259 conducted on 08/27/2020, Licensee stated that Adult 1 stayed at her house from mid-may to mid June 2020. Licensee stated that the person did not get fingerprinted and associated to the facility since it was only temporary. Today, Licensee will be cited for failing to complete a criminal record clearance for Adult 1 prior to her staying in the home which is a violation of the California Code of Regulations, Title 22. Licensee will be assessed a $500 civil penalty along with the citation.
On 09/24/2020, LPA Risher a call from a Social Worker from DCFS regarding the complaints that were received in August 2020. SW reported that the Licensee was arrested based on the allegations in the complaint #30-CC-20200824160259 and 30-CC-20200827164048. Licensee failed to provide an Unusual Incident Report for the arrest or the incident in both of the above complaints. On 10/23/2020, LPA Risher contacted the Licensee to request a UIR for the incident that occurred at the daycare as well as the arrest. As of 10/29/2020, the Licensee has failed to report the Unusual Incidents that have occurred at the daycare. Licensee will be cited for failure to follow reporting requirements under Title 22 regulations.

Please refer to LIC809d and LIC 421BG.

Exit interview was conducted. A plan of correction was reviewed and developed with the Licensee. A copy of the report will be provided to the licensee via email. Appeal rights will be provided to the licensee.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (434) 301-3061
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020
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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197493354
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/02/2020
Section Cited

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102370(d)(1) Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption...
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This requirement was not met as evidenced :Based upon the interview that was conducted on 08/17/2020, Adult 1 did not complete a criminal record clearance prior to residing in the home. This poses an immediate risk to the health & safety of the children in 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: Mary RuizTELEPHONE: (434) 301-3061
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2020
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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197493354
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2020
Section Cited

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102416.2(b)(3)(C) Reporting Requirements
The licensee shall report to the Department any of the events...Health and Safety Code Section 1597.467(b)(1) provides in part:
(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child."
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This requirement was not met as evidenced by
Based on record review, Licensee did not report the incident that is included in the complaint dated 08/24/2020 and she did not report her arrest. This poses a potential risk to the Health & Safety to the children in 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: Mary RuizTELEPHONE: (434) 301-3061
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3