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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493875
Report Date: 10/28/2021
Date Signed: 11/02/2021 12:18:32 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:FULLER FAMILY CHILD CAREFACILITY NUMBER:
197493875
ADMINISTRATOR:FULLER, MARLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 505-9749
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 12DATE:
10/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Chata Rankin & Marlo Fuller, LicenseeTIME COMPLETED:
10:32 AM
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On 10/28/2021 Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced inspection. At the initial start of the inspection Chanta Rankin, Assistant was present with Staff #2. Licensee was not present at the initial start of the inspection due to a appointment. A hour after inspection started Licensee was present at the facility. Per Licensing Information System (LIS) all adults residing and working in the home must have obtained a background clearance. During inspection Staff #2 was not associated to facility and LPA did not observed any required documents on file for Staff #2. This poses a immediate health and safety risk to children in care. LPA requested Licensee to release Staff #2 from duties and asked Staff #2 to leave the facility until all requirements are met. Licensee agreed and LPA observed Staff #2 leaving facility. LPA explained the purpose of the inspection with Staff #1 and Licensee. The purpose of this inspection is to conduct the required 1 year inspection and to ensure the standards for a Family Child Care Home are being met in accordance to California Title 22 Regulations and California Health and Safety Codes. Census were taken. LPA observed children in care not wearing mask as recommended by the Centers for Disease Control (CDC) Guidelines to prevent infection and to slow transmission of COVID-19 Pandemic. This is a potential Health and Safety Risk to children in care. LPA requested Assistant to have all children under the age of 2 years old to wear mask. Assistant gave each child a mask to wear during inspection.
Per licensee the ages of the children in care are Birth to 12 years of age. The days and hours of operation are Sunday to Sunday 24-hours a day. Licensee was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.
This is a 1 story home which contains 5 bedrooms, 2 bathrooms, a kitchen, dining room, living room, service porch, side run on side of home, front yard, backyard and detached garage. There are no bodies of water on the property. Adults residing in the home include Licensee and her Mother. Capacity as specified on the license is being maintained. Parent Board: All required postings were observed to be posted on the Parent Board: the license (in kitchen during inspection) the Notification of Parents Rights, Earthquake Preparedness and Notice of Site Visit from inspection dated (10/07/2021). The Emergency Disaster Plan was also posted.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197493875
VISIT DATE: 10/28/2021
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The ON Limits Areas are the Living room, Dining room, Bedroom #1(classroom), Bedroom #2(nursery) and Bedroom #3(classroom) and restroom #1 located in the middle of the hallway.

OFF-LIMITS to children in care are the Kitchen (used for walkway to backyard at the time of inspection), Entire back of home bedroom #4 and #5 and restroom #2. First- Aid Kit was observed by LPA and is inaccessible to children in care. LPA observed a smoke detector and carbon monoxide detector in hallway, however the carbon monoxide detector was not operable at the initial start of the inspection. During inspection the Carbon Monoxide Detector was fixed and is now operable.

LPA observed age appropriate furniture, games, learning materials and activities for children in care. All furniture was observed with no loose or sharp parts, LPA observed toys clean and in good repair. LPA observed the areas of care to be free and clear from hazards and safe for children in care. During inspection LPA observed in Class room #3 two electrical sockets had no child safety plugs. Assistant placed safety plugs into electrical sockets during inspection. The home was inspected comfort, cleanliness, telephone service, central heating and fans for ventilation. LPA observed the bathroom to be clean, the cabinets were free from all hazardous items that could pose an immediate danger to children in care. Poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to the health and safety of the children in care were inaccessible in a locked cabinet in hallway. Per Licensee, there are no weapons or firearms in the home. Per the Licensee there are no pets in home. Disaster Drill log observed last drill completed 10/21.

LPA observed two Fire Extinguisher in facility both were serviced April 2021 with tag attached. Kitchen area was inspected for inaccessibility of toxins/cleaning compounds and other potentially dangerous objects/materials. The Back yard play area was inspected for safety, potential hazards & inaccessibility to bodies of water. The Back yard is fully fenced. LPA observed an open space between the back gate pole and garage larger than 2 inches. (Photo's Taken). LPA advised assistant to barricade the open space for the safety of children. Assistant agreed. Licensee will barricade the open space.



Licensee and Staff #1 Pediatric First Aid/CPR were issued by the American Heart Association expire 03/22. Licensee and Staff #1 completed the Mandated Reporter Training on 03/20.
Children files were reviewed for required forms. During records review, LPA observed that the file of Child #1 did not contain documentation of a 15 minute check. However LPA observed on computer in home 15 minute check Log.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197493875
VISIT DATE: 10/28/2021
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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.


LPA discussed the safe sleep regulations with Licensee and Assistant. Please refer to the below linkhttps://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.

LPA discussed with Licensee play yards are to be kept free from all loose articles and objects while infants are sleeping, and no objects hanging above, over or attached to the crib or play yards. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is must be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations. During inspection LPA gave licensee a brochure on Effects of Lead Exposure. LPA instructed licensee to give a copy to all Parents/Representatives of Children in Care and to post on parent board. Licensee agreed.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197493875
VISIT DATE: 10/28/2021
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Please see 809D for documentation of deficiency. Technical Violations were given during inspection.

A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent.

The Notice of Site Visit was posted by Licensee in LPA's presence. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in the issuance of a citation and the assessment of a $100 civil penalty.

An exit interview has been conducted with, and a copy of this report, LIC 809D, Civil Penalty Assessments LIC421BG, along with Appeal Rights has been signed and provided to Licensee Marlo Fuller.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197493875
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
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PLEASE SEE BELOW DEFICIENCY FOR AMENDMENT
POC Due Date: 11/02/2021
Plan of Correction
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Type A
Section Cited
CCR
102370(d)(1)
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunterring in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/02/2021
Plan of Correction
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Licensee agrees not to have persons over 18 years of age or older present, residing or working in the home without criminal record clearance. Uncleared individual was asked to leave the facility during the inspection and individual left the facility. Licensee will provide a written statement to the Department by the POC 11/02/2021 due date on how she will continue to comply with this regulation.
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: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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