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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494269
Report Date: 11/06/2019
Date Signed: 11/06/2019 04:55:10 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:BOOKER FAMILY CHILD CAREFACILITY NUMBER:
197494269
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
11/06/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:ApplicantTIME COMPLETED:
05:00 PM
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On 11/6/2019 an announced pre-licensing inspection was conducted by Licensing Program Analyst (LPA) Jillinda Chandler and Laticia Thompson. LPA Chandler and Thompson met with applicant, Tamika Booker
who guided analyst on a tour of the facility. All areas identified on the facility sketch were inspected. This is a single family, single story home with 3 bedrooms and 2 bathrooms. All bedroom(s) and bathroom #2 will be off limit. Family members residing at facility are: applicant and applicants two adult sons .

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, central heating and air, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The first aid kit was observed, and contained the necessary medical items: tweezers, scissors,and bandages. No thermometer was present

Per applicant, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There is no pool, spa or other bodies of water on the premises. There are age appropriate toys and equipment on the premises. The smoke and carbon monoxide detectors are in operable condition. Applicant has provided proof of Preventative Health and Safety. CPR and First Aid expires 4/27/2020. Applicant has submitted an emergency disaster plan and demonstrated control of property at the above address by presenting leasing agreement.

Parents will enter the home through the side gate entering through the back door. The back yard will be used for out door activity there are no hazardous conditions. There is a detached garage applicant did not have access to the garage during the visit. Applicant will request access from landlord and a case management visit will be conducted to inspect the garage prior to licensing the home. Also the applicant shall remove the homes refrigerator from day care area.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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: BOOKER FAMILY CHILD CARE
FACILITY NUMBER: 197494269
VISIT DATE: 11/06/2019
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· Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.
· .Applicant was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and to never shake a baby to prevent the Shaken Baby Syndrome.
· Applicant was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.
· The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents.
· Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects 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; Email Address: childcareadvocatesprogram@dss.ca.gov
· Also, discussed was; Commencing September 1, 2016, SB 792, 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. Exemption were also discussed
· Beginning on January 1, 2018, AB 1207, 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
· 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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC809 (FAS) - (06/04)
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