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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494401
Report Date: 12/06/2019
Date Signed: 12/06/2019 12:41:36 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:
12/06/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Claudette FullerTIME COMPLETED:
12:55 PM
NARRATIVE
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Licensing Program Analyst (LPA), Keyona Scott, conducted an announced Pre-licensing inspection on 12/06/2019. Applicant has applied for a small capacity license. LPA met with Applicant, Claudette Fuller, and was led on a tour inside and outside of the home. Only Applicant was present during today's inspection. Applicant is fingerprint cleared and associated to the facility.

Adults living in the home includes the Applicant only. Applicant was advised that once licensed, all adults residing, working and present in the home must be fingerprint cleared and associated to the facility prior to entering or residing in the facility.

Applicant has applied to provide care for children ages six (6) weeks to thirteen (13) years old. Upon licensure, Applicant will be granted the capacity to care for up to eight children at a time; four infants only or six children with no more than three infants or eight children with no more than two infants and two school age children age six years old or older and one currently attending Kindergarten. Per Applicant, child(ren) will be provided breakfast, lunch, dinner, and three snacks throughout the day. Child Care operation hours are scheduled for Monday through Sunday, 24 hours. Per Applicant, an assistant will be hired to assist in the care of the children and will alternate sleeping schedule if children are present 24 hours throughout the day. Applicant also stated will purchase adequate sleeping equipment if a child(ren) are enrolled that require overnight care.



Applicant's home is a one story three bedroom, two bathroom home with a living room, kitchen, dining room and attached garage. Per Applicant, no childcare will be conducted in the attached garage. The attached garage is made inaccessible by closed and locked door during operation hours. The off limit areas of the home are: the master bedroom and bathroom (Applicant's bedroom), bedroom #2 (Applicant's minor child bedroom) and bedroom #3 (Applicant's minor child bedroom), the living room, kitchen and attached garage. The master bedroom, located at the entrance of the home to the left, is made inaccessible by closed door during operation hours. Bedroom #2, located through the hallway off the dining room to the rear, adjacent to the bathroom, is also made inaccessible by closed door during operation hours. Bedroom #3, also located through the hallway adjacent to bedroom #2, is made inaccessible by closed door during operation hours. The living room and kitchen, located between the master bedroom and dining room, are made inaccessible by safety gate at the kitchen entrance adjacent to the dining room. There is a fireplace located in the living room that has a glass screen with pop open doors, however, is not screened to Department regulations. There are safety latches on the drawers and cabinets in the kitchen. There is also a safety latch on the laundry area doors, located adjacent from the kitchen. The primary child care area of the home is located at the rear of the home, adjacent to the dining room. LPA observed toys, chairs, cubbies, books, table and chair set in the child care area. The children will also utilize the dining room area as a homework area and eating area for the older children in care. LPA observed a playyard, changing pad and napping cots stored in the dinning room. The children will use the bathroom that is located through the hallway off the dining room, to the right. There is a safety latch on the cabinet, located under the sink in the bathroom. Page 1
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197494401
VISIT DATE: 12/06/2019
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Per Applicant, parents enter through the side gate to the right of the home to drop off and pickup child(ren). Once the parent enters through the side gate, parents will come to the back of the home to the play area door located at the rear of the home.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Home utilizes centralized heat and air conditioning system as heating and cooling sources. Home has a working telephone. Hazardous materials in the kitchen and bathroom are inaccessible to children. All poisons are locked. According to the licensee, there are no weapons or firearms at the home; None were observed by LPA. Per Licensee, there are no pets in the home; none were observed by LPA.



Applicant has submitted an Emergency Disaster Plan to the Department. The Emergency Disaster Plan is posted on the Parent Board in the child care area of the home.

The home is equipped with a fully charged fire extinguisher which is at least a 2A:10:BC. The home is equipped with a working smoke detector and carbon monoxide detector. There is a first aid kit in the home. LPA observed current Pediatric CPR and First Aid certificate for Applicant with an expiration date of 09/07/2021. Mandated Reporter training was completed on 03/30/2018. Applicant completed Preventative Health and Safety training with one hour of Nutrition training on 10/20/2019. Applicant also completed Family Child Care Orientation on 07/23/2019.

There are age appropriate toys and playthings for the children in the home. Applicant agrees that no baby-walkers, bouncers, jumpers, exersaucers and similar items will be used for children in care and are kept inaccessible.


The outdoor play area is located in the backyard of the home. The outdoor play area is fully fenced in and is free from defects and dangerous conditions. There is a covered patio area at the exit to the backyard of the home from the child care area. Per Applicant, children will eat on the patio as weather permits. Applicant stated has purchased table and chair for patio and awaiting delivery. No pools, spas, hot tubs, fish ponds, or similar bodies of waters observed during the inspection. LPA observed age appropriate play apparatus with slide and swings in the the outdoor play area in the backyard.

Applicant was informed that it is required by law to post the following in the facility:
● Emergency Disaster Plan (LIC 610A) - This must be posted in your home next to the telephone and the Earthquake Preparedness Checklist (LIC 9148), must be attached to the LIC 610A and available to the public.

● Notification of Parents' Rights Poster (PUB 394) - This poster must be placed in an area of the home where all parents can see it


● Facility License, (LIC 203)-Your Family Child Care Home License must be posted in an area of the home where it can be easily seen.
● Notice of Site Visit (LIC 9213) must remain posted for 30 days (during the hours that children are in care) after each site visit by a licensing representative.
● Any licensing report documenting a type “A” citation must be posted for 30 days during the hours that children are in care.
● Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Page 2
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
LIC809 (FAS) - (06/04)
Page: 2 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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197494401
VISIT DATE: 12/06/2019
NARRATIVE
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Employee records must be maintained by the applicant and shall contain the following:
LIC9052/Employee Rights, LIC 9108 Mandated Reporter Form, an employment contract or application containing the following information: Employees Full Name, Date of Birth, Driver's License Number, Date of Employment, Documentation of Health and Safety Training, Duties of the employee. Licensee is reminded that records for employees as well as children must be maintained for 3 years after separation from the Family Child Care Home (FCCH).

Mandatory Forms for the Children’s files shall contain the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization (Blue) Card.

Applicant also informed children records and facility roster must be kept for 3 years and advised all public reports must be kept for review. Forms and Regulations available at: www.ccld.ca.gov.



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.

Applicant was reminded, upon licensure it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Applicant was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

Applicant 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 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


Email Address: childcareadvocatesprogram@dss.ca.gov

Senate Bill 792: 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. LPA discussed the influenza waiver during the inspection.

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

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
LIC809 (FAS) - (06/04)
Page: 3 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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197494401
VISIT DATE: 12/06/2019
NARRATIVE
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New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

***CCC - 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.

Mandated Reporter: 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. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/.

The Applicant was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office within 24hours of the Unusual Incident and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.

Applicant informed Fire disaster drills are to be conducted at least once every 6 months and log must be kept.

Applicant 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 made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.



Applicant was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

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

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
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: FULLER FAMILY CHILD CARE
FACILITY NUMBER: 197494401
VISIT DATE: 12/06/2019
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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 licensee 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. Applicant was advised that each parent or child representative must sign the LIC 9224 Acknowledgement of Receipt of Licensing Report and return by the close of the business day or upon the next day the child returns to the facility or upon a newly enrolled child within the next 12 months and place the LIC 9224 in each child's file.

Applicant was provided the following forms/brochures:
PIN 19-02-CCP: Safe Sleep Awareness Campaign
NIH Pub. No. 18-HD-5759: What Does A Safe Sleep Environment Look Like?
A Child Care Provider's Guide to Safe Sleep
Safe Sleep in Child Care
LIC 311D: Forms/Records To Keep In Your Family Child Care Home
Copies of All Required Forms/Records for Children and Personnel Listed on the LIC 311D
PUB 394: Notification of Parents' Rights Poster
PIN 19-09-CCLD Division Mailchimp Account Information... Subscribe For Updates
SafeBaby2indd- Safe Sleep

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

At this time, the facility is not ready for a licensure.

Prior to licensure, the following must be completed within 30 days or the application can be denied:

  1. Secure screened fireplace according to Department Title 22 Regulation

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: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5