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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494401
Report Date: 12/10/2019
Date Signed: 12/10/2019 12:07:34 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:FULLER FAMILY CHILD CAREFACILITY NUMBER:
197494401
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/10/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Claudette FullerTIME COMPLETED:
12:23 PM
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Licensing Program Analyst (LPA), Keyona Scott, conducted an announced follow-up Pre-licensing inspection on 12/10/2019. Applicant has applied for a small capacity license. LPA met with Applicant, Claudette Fuller, and was led on a tour of the home on 12/10/2019 at 11:13 AM. All adults present, working and residing in the home are fingerprint cleared and associated to the facility.

The purpose of today's inspection was to check the fireplace to verify the fireplace, in the living room, is securely screened to Department Regulation.

LPA observed and inspected screened fireplace in the living room, was securely screened and bolted in place. LPA also observed and inspected the screen to have a opening door which was closed and secured with a safety latch.

The following was thoroughly discussed with the Applicant:



All adults living and working in the home must be fingerprinted and cleared prior to entering the facility. 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. The Applicant may find additional information and forms on the DSS 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.
After licensure, Licensee can be cited a civil penalty of $100 per day, up to $500.00 for the 1st offense and up to $3000.00 for the 2nd offense within a 12-month period, PER PERSON.
Upon a finding of noncompliance with a plan of correction for violations of Sections 102419(a)(8), (b), (c), (d), (d)(1), or (d)(2), the Department shall impose a civil penalty of fifty dollars ($50) per day until the deficiency is corrected. Subsequent violations of any provision of these sections within 12 months of the initial citation will result in a civil penalty of $150 plus an assessment of $50 per day until the deficiency is corrected.
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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197494401
VISIT DATE: 12/10/2019
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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 that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome

The applicant was also recommended the following safe sleep practices: always place infants on their backs for sleeping; use only a tight-fitting sheet on the crib or play yard mattress; do not hang any items from the crib or above the crib; keep all items, including blankets, out of the crib or play yard; pacifiers may be used as long as they do not have items attached to them; infants should not be swaddled or have any items covering them while sleeping; the temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold. Please note, these guidelines are recommendations for best practices only, until regulations are approved and adopted.

The applicant was advised that, once licensed, 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, (Type A violation), 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.

LPA discussed AB633 and informed applicant that, upon receipt of a Type A deficiency, the licensee shall post and provide copies of the 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.

All adults living and working in the home shall be made aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

New Appeal Process: A licensee may file an appeal, in writing within 15 business days from the date of receiving the penalty assessment

At this time, the facility is ready for licensure. The facility was operating within substantial compliance during today's inspection on 12/10/2019. The Department agrees to the licensure of the facility for up to 8 children. MAX. CAPACITY 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. MAX. CAPACITY 6 - NO MORE THAN 3 INFANTS or 4 INFANTS ONLY.

An exit interview was conducted and a copy of this report was given to the Applicant, Claudette Fuller, whose signature confirms today’s Pre-licensing inspection and report.

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
LIC809 (FAS) - (06/04)
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