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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493354
Report Date: 01/04/2021
Date Signed: 01/05/2021 12:44:47 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: 0DATE:
01/04/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
07:00 PM
MET WITH:Anita Kaufman, LicenseeTIME COMPLETED:
07:15 PM
NARRATIVE
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On 01/04/2021 at 7:00 pm, Licensing Program Analyst (LPA) Sabrina Martinez conducted a Case Management- Deficiencies tele-visit inspection for the purposes of citing for the deficiencies that were observed during the investigation of Complaint CONTROL NUMBER 30-CC-20200824160259.

During the investigation, it was revealed that Anita Kaufman, licensee, allowed Adult #1 to live in the family child care home from mid-May 2020 until mid-June 2020. It was also revealed that Adult #1 was providing care and supervision without evidence of a current tuberculosis clearance and documentation of the required immunization or exemptions from immunization. Furthermore, it was revealed that on 06/30/2020, Adult #1 was left alone supervising children in care without a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation (First Aid & CPR). The facility was issued Type B citations in violation of Title 22 regulations. (See LIC 809-D for deficiency page).

The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.

An exit interview was conducted with Anita Kaufman, licensee. A copy of this report and appeal rights are being emailed to licensee and LPA explained that a reply to the email shall be considered a substitute for the hard-copy signature.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2021
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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197493354
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/04/2021
Section Cited

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Application for license. Evidence of a current tuberculosis clearance, as defined in regulations that the department shall adopt, for any adult in the home during the time that children are under care...This requirement is not met as evidenced by: On 06/30/2020, licensee permitted Adult #1 to provide care and supervision to children without
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obtaining evidence of a current tuberculosis clearance for Adult #1. This is a Type B citation and poses a potential health and safety risk to children in care.
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Type B
01/04/2021
Section Cited

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Personnel Requirements. A licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility, or when children are off-site of the facility for facility activities....
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This requirement is not met as evidenced by: On 06/30/2020, licensee permitted Adult #1 to supervise the day care children alone without having current CPR/First Aid
certifications. This is a Type B citation and poses a potential health and safety risk to 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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2021
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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197493354
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/04/2021
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemption. Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
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This requirement is not met as evidenced by: On 06/30/2020, licensee permitted Adult #1 to provide care and supervision to day care children without documentation of the required immunizations. This is a Type B citation and poses a potential health and safety risk to 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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3