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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493960
Report Date: 08/24/2021
Date Signed: 08/24/2021 04:41:48 PM

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:FULLER FAMILY CHILD CAREFACILITY NUMBER:
197493960
ADMINISTRATOR:FULLER, TERRIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 739-1824
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY:14CENSUS: 4DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Terri Fuller, LicenseeTIME COMPLETED:
04:55 PM
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Prior to entrance to the facility, LPA Mayra Rivera conducted a Covid 19 assessment and based on the licensee responses to the facility assessment questions, LPA Rivera determined safe to proceed. On Tuesday, August 24, 2021 at 2:18 PM, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with Licensee Terri Fuller who guided LPA Rivera on a tour of the facility.

During the inspection, 4 children were present. LPA Rivera observed 3 children napping one infant with licensee. The preschool children were sleeping on mats. Family members residing in the home has been discussed with licensee and are cleared. Operating hours are Monday to Sunday,12::00 AM to 11:59 PM and care for children ages 0 to 12 years.

This facility is a one-story home that consists of there bedrooms, two bathrooms, kitchen, living room, dinning room, and front yard (gated). Areas that are accessible to children and identified on the facility sketch were inspected by LPA Rivera; living room, dining room, bathroom daycare room and front yard.

Areas off limits to children include- master bedroom, kitchen, office room and bedroom #2 and backyard. At 2:10 PM, LPA observed a safety gate barrier in place between the daycare room and living dining room.

At approximately 2:25 PM LPA Rivera entered the daycare room area to inspect for safety, comfort, cleanliness, ventilation and working phone (land line). For ventilation, LPA Rivera observed central AC/heater vents located on the ceiling walls. LPA observed a cubby storage with children personal belongings and the furniture and children materials to be in good condition and age appropriate.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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 4
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197493960
VISIT DATE: 08/24/2021
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At approximately 2:30 PM, LPA Rivera entered the restroom and observed the toilet, running water, and hand soap. LPA did not observe paper towels and advised licensee to utilize paper towels due to hand towel accumulates bacteria. LPA observed the bottom cabinets closed and with a child proof lock in place making it inaccessible to children to open cabinet doors. LPA observed medication inside the medicine cabinet and advised to place the medication in an area inaccessible to children even though preschool children cannot reach but school age children can. No school age children present during the inspection.

At approximately 2:37 PM LPA observed cleaning compounds items stored inside the bottom kitchen sink cabinets. LPA advised to place a child proof lock to make inaccessible to children to open.. Licensee understands that any poisons or firearms must be locked with a key or combination lock. For drinking water, LPA observed filtered water on the refrigerator and licensee uses disposable cups.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has no pets. firearms, or weapons. LPA did not observe firearms, weapons 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 2:36 PM LPA Rivera observed the required 2A10BC fire extinguisher located inside the bottom kitchen sink and the valve on the green area indicating fully charged and serviced on 10/3/2018. Licensee stated the inspector came out in the first week of August. LPA observed the smoke detector in the living room and heard the sound of the detector. LPA observed carbon monoxide detector in the daycare room and observed the green flashing light flashing on the carbon monoxide detector.

At approximately 4:10 PM, LPA Rivera inspected the outdoor area for safety, comfort and cleanliness. The facility was observed to be free of flies, insects and rodents. LPA observed a carport and provides adequate shade in the front yard. LPA observed the side gate closed and locked with a key padlock. LPA observed a passenger van in the front yard and passenger doors closed locked.

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

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197493960
VISIT DATE: 08/24/2021
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LPA observed licensee incorrect First Aid/ CPR certification and LPA informed the required certification is the Pediatric First Aid/ CPR Adult-Child-Infant. Licensee has proof of immunization against pertussis, MMR and LPA received influenza declination dated 8/24/21. Licensee has completed the mandated reporter (AB 1207) training on 3/29/21. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.

At approximately 2:50 PM LPA reviewed licensee and child #1 file. LPA issued the Children's Record Review (LIC 857) to licensee during the inspection.

At approximately 2:58 PM LPA reviewed the children roster, and observed on the bulleting board the LIC 610A Emergency disaster plan, LIC 9148 Earthquake Preparedness Checklist, PUB 394 parents rights, facility sketch, emergency drill with last drill conducted on 8/9/21.


The following was discussed
INFANT CARE: LPA Rivera reviewed and discussed Safe Sleeping Practices information with licensee and a plan for supervising sleeping infants. LPA advised the licensee to sleep infants in an area where infants can be directly supervised. Place infants on their backs to sleep, on a firm mattress with fitted sheet that fits snugly in crib or play yard. LPA also advised against sleeping infants in a separate room with no direct supervision and no pillows, crib bumpers, swaddling, head covered, and pacifiers must not have anything attached. Safe sleep brochure was provided.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPAs also explained to licensee that car seat, stroller are only and only for 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: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197493960
VISIT DATE: 08/24/2021
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LPAs advised the licensee how to access forms, regulations and quarterly updates , and Providers Information Notices (PIN) online at: www.ccld.ca.gov

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Licensee has been given a technical violation for incorrect CPR certification. Exit interview was conducted and plans of correction were reviewed and developed with Licensee Terri Fuller with due date September 7, 2021. . A copy of this report and appeal rights were discussed and left with licensee, Terri Fuller whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4