197494338-8-26-2021-30-CC-DMIA-C69P2U-20210826105632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494338
Report Date: 08/26/2021
Date Signed: 08/26/2021 10:56:38 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:	ANDREWS FAMILY CHILD CARE		FACILITY NUMBER:	197494338
ADMINISTRATOR:	ANDREW, FELICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	3235169341
CITY:	GARDENA	STATE: CA	ZIP CODE:	90247
CAPACITY:	14	CENSUS: 3	DATE:	08/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Felicia Andrew, Licensee		TIME COMPLETED:	11:05 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 0826/2021 8:20AM, Licensing Program Analyst (LPA) Miranda, conducted an unannounced Annual Required Inspection and was met by Licensee, Felicia Andrews. Also present was a mother with her two children. Per licensee and children's mother there are in process to enroll the two children today. Days and hours of operation are 24 hours, from Saturday to Sunday. LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed. Licensee confirmed that the house has 2 bedrooms, one bathroom, living room, kitchen and attached garage. The garage was observed, and Licensee is using only for storage. Areas that are accessible to children are as follows: Living room, bathroom, backyard and front yard with fenced. There are no firearms or ammunition on the premises and no pets. 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 are electronic fireplace at the premises, per licensee no wood needs to use. LPA observed fireplace with screen. 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, however, during outdoor play licensee will have safety gate at the stairs of the building. The home has working telephone service and LPA confirmed the phone number is (323) 516-9341. During this inspection, there is 1 infant and one preschooler child that mother was in process to enroll the child and the grandchild’s of the Licensee.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: ANDREWS FAMILY CHILD CARE	FACILITY NUMBER: 197494338
	VISIT DATE: 08/26/2021

NARRATIVE

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LPA discussed Safe Sleep Regulations with licensee. There is one mini play yards available, play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.
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 is located at the bottom of the front yard the apartment which is fenced off and no hazards to children present. Applicant will have a gate at the bottom of the stairs during play time as a security measure. The entrance to the facility is located in the alley and parents will drop off and pick up from the alley.
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 completed on 04/23/2021. Licensee’s pediatric CPR/First Aid expires on 05/30/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.
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

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: ANDREWS FAMILY CHILD CARE	FACILITY NUMBER: 197494338
	VISIT DATE: 08/26/2021

NARRATIVE

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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.

A advisory notes was provided to licensee

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.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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