197494259-9-23-2021-30-CC-SGUZ-C73QMA-20210921121709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494259
Report Date: 09/21/2021
Date Signed: 09/23/2021 03:47:43 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:	LEE FAMILY CHILD CARE		FACILITY NUMBER:	197494259
ADMINISTRATOR:	DIANE NAYOUNG LEE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 270-4044
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	14	CENSUS: 10	DATE:	09/21/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Diane Lee		TIME COMPLETED:	12:30 PM

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On 09/21/2021 Licensing Program Analyst (LPA), Stella Gutierrez conducted an unannounced Annual Required Inspection and was met by Licensee, Diane Lee. Also present was Assistant, Lynsey Carmano . Days and hours of operation are Monday-Friday 8:00am-6:00pm.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the bathroom, family room, bedroom 1, and are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of locks. 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. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The fireplace is located in living area that is barricaded with cubbies to make inaccessible. 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 (213) 270-4044.

There are currently 3 infants in care. LPA discussed Safe Sleep Regulations with 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. 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’s Mandated Reporter Training was observed to be expired 06/2021. Licensee stated that she will complete this requirement and send to LPA via email by Friday 09/24/2021 5pm . Licensee’s pediatric CPR/First Aid expires on 05/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. Page 1 of 2

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Stella Gutierrez	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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: LEE FAMILY CHILD CARE	FACILITY NUMBER: 197494259
	VISIT DATE: 09/21/2021

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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.

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 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.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Stella Gutierrez	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

LIC809 (FAS) - (06/04)

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