197493887-8-9-2021-30-CC-SGAN-C5QRWL-20210809132320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493887
Report Date: 08/09/2021
Date Signed: 08/09/2021 01:23:36 PM

Document Has Been Signed on 08/09/2021 01:23 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	ADLER FAMILY CHILD CARE		FACILITY NUMBER:	197493887
ADMINISTRATOR:	ALDER, EMMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 433-4187
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90066
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Emma Alder/Licensee		TIME COMPLETED:	01:20 PM

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On 08/09/2021 Licensing Program Analyst (LPA) Silva Garibyan, conducted an unannounced Annual Required Inspection and was met by Licensee, Emma Adler. Also present was Staff #1 (S1). Days and hours of operation are M-F 9:00 AM to 4:00 PM.

LPA toured the home inside and outside and a census was taken. There were no children present at the time of the visit. Current facility sketch reviewed and Licensee confirmed that the entire home will be accessible to the children in care for the exception of the front yard which will only be used for pick-up/drop-off for the children. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is an open face heater in the dining area that is properly screened. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (310) 923-6291.

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

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: ADLER FAMILY CHILD CARE	FACILITY NUMBER: 197493887
	VISIT DATE: 08/09/2021

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There are no infants in care. LPA discussed Safe Sleep Regulations with licensee.

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. The outdoor play area in the backyard is fenced and there are no hazards to children present. The side gate in the backyard that leads to the front of the home is kept closed all times while children are in care. There is a back door observed behind the children's swing set that leads to an alley way and a padlock is placed on the back door to make inaccessible to children in care. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee had not completed the renewal Mandated Reporter Training. Licensee’s pediatric CPR/First Aid expires on 04/03/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

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.

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

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: ADLER FAMILY CHILD CARE	FACILITY NUMBER: 197493887
	VISIT DATE: 08/09/2021

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All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

LIC809 (FAS) - (06/04)

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