197494259-10-17-2019-30-CC-MCON-BH2NMF-20191017103505

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494259
Report Date: 10/17/2019
Date Signed: 10/17/2019 10:35:34 AM

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:	LEE FAMILY CHILD CARE		FACILITY NUMBER:	197494259
ADMINISTRATOR:	DIANE NAYAING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 270-4044
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	14	CENSUS: 0	DATE:	10/17/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Diane Lee, Applicant		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On October 17, 2019 at 9:00 AM, Licensing Program Analyst (LPA) Miriam Cohen made an announced visit to the location 23621 Kentworthy Avenue, Harbor City, CA 90710 for the purposes of conducting a pre-licensing inspection. The home is a one story, two bedrooms and two-bathroom home with a family room, kitchen, and dining area. Family members residing in the home consist of the following: applicant and spouse. The main day care area shall be conducted in the living room for daytime activities with sleeping accommodation. Infant shall nap in the napping room adjacent to the family. The master bedroom, daughter’s bed room, family room, kitchen, and garage room are off limits to children in care. Applicant installed safety latch and safety gate to make off limits area inaccessible to children in care. All areas of the home were inspected according to the LIC. 999A- facility sketch. LPA observed the Following: Fire safety requirements: Fire extinguisher, smoke and carbon monoxide detectors present and operable Applicant is currently certified in Pediatric CPR/First Aid with the required eight hours’ nutrition class Toys and equipment are observed and in good repair All toxins and detergents are in locked/latched cabinets Home has central heating and air condition Applicant states that there are no guns/weapons in the home LPA did not observe firearms and other dangerous weapons during the inspection LPA did not observe pets The following items were discussed with the applicant: Requirements for fire drills, earthquake drills, and documentation for both. Also discussed was earthquake safety and necessity of drills twice a year.* *The role and responsibilities of being a mandated reporter were discussed.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: LEE FAMILY CHILD CARE	FACILITY NUMBER: 197494259
	VISIT DATE: 10/17/2019

NARRATIVE

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*Mandatory Forms for the children’s files and provider’s files.
*The applicant is advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Applicant was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.
*The licensee is advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times. If the phone number has changed, licensing must be notified.
*Regulation prohibits the smoking of tobacco on the premises.
*State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.
*All infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome).
*The provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.
*Only children eating may be in high chairs and that car seats are utilized only for transportation.
*Requirements for fingerprint clearances and associations are discussed with the licensee.
The applicant was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day up to $500.00 (5 days) for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12-month period. The applicant may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.
*The applicant was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division.
*LPA signed up applicant to receive Quarterly Updates. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: LEE FAMILY CHILD CARE	FACILITY NUMBER: 197494259
	VISIT DATE: 10/17/2019

NARRATIVE

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*The applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and licensing within the time frame specified by the regulation.
*The "Notification of Parent's Rights" (PUB394) poster must be posted in an area accessible to parents.
*LPA discussed AB633 and informed applicant that, upon receipt of a Type A deficiency, the applicant/licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
*Complaints shall be reported by applicant/licensee and/or parents to the complaint hotline at (844) 538-8766 and for general information and incident reporting; contact their local child care office.
*AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
*Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.
*Update on Incidental Medical Services (IMS):
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.
IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.
Incidental Medical Services (IMS) policy was discussed. For further 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: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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: LEE FAMILY CHILD CARE	FACILITY NUMBER: 197494259
	VISIT DATE: 10/17/2019

NARRATIVE

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*Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university.
*New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.
*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 a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).
While operating as a small family child care home Applicant may operate one of 3 ways: 4 infants only. Maximum Capacity 6 children with no more than 3 infants and 3 children over the age of 2 years old. Maximum Capacity 8 children with no more than 2 infants, and 2 children who are enrolled in kindergarten or elementary school and 4 children two years old or above.

Applicant was informed of the following items that must be posted in visual site once licensed.
(1) License (2) Emergency Disaster Plan (3) Children’s Roster (4) Parents Rights Poster PUB 394, Personal Rights LIC 613-A Recent regulatory changes were discussed.

The above topics were discussed, and an exit interview was conducted with the applicant, Diane Lee.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: LEE FAMILY CHILD CARE	FACILITY NUMBER: 197494259
	VISIT DATE: 10/17/2019

NARRATIVE

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Below are forms, found at www.ccld.ca.gov, that the applicant shall use for record keeping and posting requirements:
LIC 9040 Child Care Facility Roster (Retain for 3 years) most recent must be posted
LIC 9148 Earthquake Preparedness Checklist
LIC 627 Consent for Medical Treatment
LIC 702 Child's Preadmission Health History-Parents Report
LIC 995 Notification of Parent's Rights
PUB 394 Notification of Parent's Rights Poster 12/06 (issued & discussed)
LIC 613-A Personal Rights
LIC 700 Identification and Emergency Information
LIC 282 Affidavit Regarding Liability for Family Child Care Homes
LIC 9224 Acknowledgement of Receipt of Licensing Reports 12/06 (issued & discussed)
Title 22, Division 12 Regulations (access website)

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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