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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493592
Report Date: 09/30/2022
Date Signed: 09/30/2022 02:31:41 PM


Document Has Been Signed on 09/30/2022 02:31 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:BROWN FAMILY CHILD CAREFACILITY NUMBER:
197493592
ADMINISTRATOR:SHANICE BROWNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
7149042765
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY:14CENSUS: 14DATE:
09/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Shanice Brown, LicenseeTIME COMPLETED:
03:32 PM
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On Friday, September 30, 2022 at 10:25 a.m.,Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with Licensee Shanice Brown who guided LPA Rivera on a tour of the facility.

During the inspection, 3 infants and 11 preschool children were present and one assistant. Family members residing in the home has been discussed with licensee and have obtained a criminal record clearance or exemption. Operating hours are Monday to Friday, 8:00 a.m. to 6:00 p.m and care for children ages 0 to 13 years.

This facility is a one-story home that consists of four bedrooms, two bathrooms, kitchen, living room, dining room and front yard and backyard (fenced and gated). Areas that are accessible to children and identified on the facility sketch were inspected by LPA Rivera; bedroom #3, #4 and bathroom located in the back house and backyard. Areas off limits to children include- living room, kitchen, and the two bedrooms #1 and #2 located in the front of the house by the living room.

At approximately 10:40 a.m., LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Rivera observed ceiling fans, swamp coolers and two wall heaters located in the living room and hallway. LPA did not observe the wall heaters with fire screen protector and advised to place a screen protector. LPA observed the furniture and children materials to be in good condition and age appropriate.

At approximately 11:04 a.m, LPA Rivera entered the restroom and observed a toilet, hand washing sink, hand soap and paper towels. LPA did not observe any hazards and observed the restroom and hand washing sink area to be in good condition.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BROWN FAMILY CHILD CARE
FACILITY NUMBER: 197493592
VISIT DATE: 09/30/2022
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At approximately 11:13 a.m., LPA observed cleaning compounds items stored in the side kitchen cabinet with a child proof lock making it inaccessible for children to open. Knives and sharp objects, LPA observed the items inside the kitchen drawer with child proof locks making it inaccessible for children to open the drawers. For drinking water, licensee provides water bottles and disposable cups.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has two dogs, no body of waters, no firearms, no weapons or poisons. LPA observed two dogs, in the off-limits bedroom did not observe firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At approximately 11:23 a.m., LPA Rivera observed the correct 2A10BC fire extinguisher located in the kitchen and the valve on the green area indicating fully charged and serviced on 8/16/22. LPA observed the smoke detector in the living room. The smoke detector was tested. LPA observed the combo smoke detector/carbon monoxide detector in the dining room and detector was tested. LPA heard sound of the detectors and are in operable condition. LPA also observed and emergency kit/first aid kit in the kitchen and fully equipped with bandages, gauzes, ice pack and roller bandages.. LPA observed the fire/earthquake drill log and last drill conducted on 9/18/22

At approximately 11:30 a.m., LPA Rivera inspected the outdoor area used by children for safety, comfort and cleanliness. LPA observed the equipment to be age appropriate and in safe condition, free of sharp, no loose or pointed parts. LPA observed trees and a E-Z up canopy and provides adequate shade. LPA observed play equipment to be in good condition and age appropriate. LPA observed a side gate and the garage door close and locked with a key pad lock. LPA observed a playground structured and observed wood chips and advised to either add more wood chips or add another layer of cushion padding that absorbs a fall.

LPA observed licensee incorrect Pediatric First Aid/ CPR certification (online course), no proof of the Health and Safety (8 hour) certification, no proof of immunization against Pertussis, MMR and Influenza or influenza declination. Licensee has completed the AB 1207 Child Abuse Mandated Reporting training on 8/1/2022. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BROWN FAMILY CHILD CARE
FACILITY NUMBER: 197493592
VISIT DATE: 09/30/2022
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At approximately 12:15 p.m., LPA reviewed children’s records and reviewed child #1, #2 and #3. LPA observed child #1 file to be completesd and child #2, #3 files to be incomplete. Staff #2 missing MMR immunization. Child #2 immunization's need to be updated and missing LIC 9150 Receipt of Parent Notification Additional Child in Care and Child #3 missing LIC 9150 Receipt of Parent Notification Additional Child in Care and immunization records.

At approximately 12:55 p.m.,staff records were reviewed. LPA observed licensee file to be incomplete. Licensee is missing proof of immunization's (MMR, TDAP, and Influenza or influenza Declination), proof of the Health and Safety Certification, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Staff 2 missing LIC 501 Personnel Record, , LIC 9052- Employee Rights, Proof of immunization's against measles,

Safe Sleep: LPA discussed the safe sleep regulations with assistant Olivia Brown 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 Shaniece of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at also explained to licensee that car seat, stroller are only and only for https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPA transportation, highchair is only and only for feeding and stated items cannot be misused. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.



Medication: Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BROWN FAMILY CHILD CARE
FACILITY NUMBER: 197493592
VISIT DATE: 09/30/2022
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Criminal Record Statement: Licensee Shaniece Brown 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.

Licensee has been given 2 Type B Violations for incorrect Pediatric First Aid/ CPR certification and missing proof of immunization record for licensee and staff 2 missing proof of MMR. Technical violations for two wall heaters not having a fireproof screen protector, licensee having the play pens missing fitted sheets, child #2 and #3 files incomplete. Licensee has been informed she has 30 days to correct the violations.

LPA Rivera provided information in how to utilize Guardian.

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

Exit interview conducted and report was reviewed with the assistant Olivia Brown.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 09/30/2022 02:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: BROWN FAMILY CHILD CARE
FACILITY NUMBER: 197493592

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in having the incorrect Pediatric First Aid/CPR certification which poses a potential health,safety risk to persons in care.
POC Due Date: 10/28/2022
Plan of Correction
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Licensee Shanice Brown enrolled to take the required Pediatric First Aid/CPR certification. Date of enrollment 10/1/22 at 8:00 a.m.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above not having proof of immunizations MMR, TDAP, Influenza of Influenza Declination which poses a potential health, safety risk to persons in care.
POC Due Date: 10/28/2022
Plan of Correction
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Licensee stated she is going to contact Kaiser to obtain records of her immunizations the week of October 3, 2022.

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: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022
LIC809 (FAS) - (06/04)
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