197494458-9-25-2020-30-CC-DMIA-BTSNXS-20200925105137

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494458
Report Date: 09/25/2020
Date Signed: 09/25/2020 10:52:00 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:	TENG FAMILY CHILD CARE		FACILITY NUMBER:	197494458
ADMINISTRATOR:	TENG, I CHEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 232-7395
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90066
CAPACITY:	14	CENSUS: 0	DATE:	09/25/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Chen Teng, Applicant		TIME COMPLETED:	11:00 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 9/25/2020 at 8:00am, Licensing Program Analyst (LPA) Denise Miranda met with Yi Chen Teng, applicant, for the purpose of a pre-licensing inspection. Applicant has applied for a large family child care home license. LPA did not observe any day care children present on the premises. Present at the time of the inspection was Yi Chen Teng, applicant. LPA verified that all adults present in the home have obtained criminal record clearances and are associated to the facility and TB clearance. Applicant states hours of operation for daycare are Monday-Friday, 8:00 am to 5:00 pm. Applicant was advised during hours of child care that the applicant shall be present in the home and shall ensure children in care are visually supervised at all times. All areas identified on the facility sketch were inspected. The facility is located in a duplex home, was inspected the indoor and door and did not match the physical plant of the house. The house is a single-story home with 1 bedroom and 1 bathroom, 1 living room with a open concept with a kitchen and a detached garage. Children and parents in the family child care home will enter the facility through the side gate of the home located at Louise Avenue, Los Angeles, CA 90066. Gate has a code that will provide to parent's of the children in care. Day care will be conducted in living room and will be use as isolation area for sick children the corner of the living room. Children will use the front yard of the house and the deck area only for outdoors activity. Applicant was informed that there's no commingling of children and these areas have two separate properties. licenses. Applicant provided a declaration that she understand that the back yard, the back side (access trought her kitchen area) of the property will be off limit, and she will not commingle children in care with next door located at 4256 Inglewood Blvd, Los Angeles, CA 90066 (Baranova Family Child Care) or any

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

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: TENG FAMILY CHILD CARE	FACILITY NUMBER: 197494458
	VISIT DATE: 09/25/2020

NARRATIVE

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other facilities.

The following was observed:
The home has age appropriate toys. Electrical outlets have child protective covers in place making them

inaccessible to children. Poison or dangerous items are stored/locked in cabinets and made inaccessible. Licensee states there are no firearms in the home. There are no bodies of water on the premises and no pets. LPA did not observe weapons at the time of inspection.

The valve on the required 2-A:10-B:C fire extinguisher indicates fully charged. Fire alarm and carbon monoxide detectors that meet statutory requirements were observed during this inspection
Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central air),
Applicant completed health preventive and safety training with 1 hour nutrition completed on 11/29/2019, has current pediatric first aid CPR AED, certificate which expires in 06/29/2021 and Lead Poisoning Prevention completed on 09/23/2020.
The following was also observed by LPA during the inspection:
1. Adults living in the home have submitted fingerprints and child abuse index check forms to Department of Justice.
2. Home is neat and clean.
3. Home is equipped with a fire extinguisher (2-A:10-B:C)
4. Home has a working smoke alarms and a carbon monoxide detector.
5. Home has a working telephone.
6. All poisons are locked.
7. Hazardous materials are kept out of the reach of children (inaccessible):
kitchen: all sharp utensils and cutlery, cleaning supplies, medicines, drawers and cabinets with liquor, plastic bags, and sharp things or small things children can swallow made inaccessible to children.
Bathroom: shampoo, mouthwash, toothpaste, medicines, and perfumes/lotions/cosmetics are made inaccessible to children.
8. According to the licensee, there is no firearm at the home. None were observed by LPA.
9. Outdoor (front yard) play area is fenced in.
10. Toys and playthings are safe, clean, and appropriate for the age of the children.
11. Applicant agrees that not have baby walkers, bouncers, jumpers, and similar items will not be used for

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

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: TENG FAMILY CHILD CARE	FACILITY NUMBER: 197494458
	VISIT DATE: 09/25/2020

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children in care and are kept inaccessible.
12. LPA observed preventative health and safety training certificate, Lead Poisoning Prevention.

13. The home is equipped with a first aid kit.

14. LPA reviewed the emergency disaster kit (see note below).
The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.
Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 (5 days) for the 1^st offense and up to $3000.00 for the 2^nd offense within a 12-month period.
-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license, immunization, mandated reporter certification and preventive and health with 1h nutrition certificate. -A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. -Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. -The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check, and batteries replaced as needed. -Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. -Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). -Fire and safety drills must be performed every six months and documented for review by the Department. -Smoking is prohibited in a family child care home. -Children and Staff records must be maintained and updated as needed and must be available for review by the Department. -Pets are recommended to be isolated from children in care.

- No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

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: TENG FAMILY CHILD CARE	FACILITY NUMBER: 197494458
	VISIT DATE: 09/25/2020

NARRATIVE

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In addition, LPA distributed LIC-311D and explained the following forms:
LIC311D:
CHILDREN RECORDS: LIC: 700 Identification and Emergency Information, 702 Child’s Pre-admission Health History LIC 995E Caregiver Background Check Process, 995A Notification of Parent’s Rights, 627 Consent For Emergency Medical Treatment, 613A Personal Rights, LIC282 Affidavit Regarding Liability Insurance, LIC9150 Parent Notification, Additional Children in Care.

FACILITY RECORDS:

LIC9149 Property Owner/Landlord Consent, PUB 394 Notification of Parents Rights, PUB 269 California Child Passenger Safety Law, LIC 9040 Facility Roster, LIC624A Death Report, LIC6101A Emergency Disaster Plan, LIC9148 Earthquake Preparedness Checklist, LIC 624 Unusual Incident/Injury Report. LIC311D Forms/Records to keep In Your Family Child Care Home, Family Child Care Self-Assessment Guide.
STAFF RECORDS:
LIC 508 Criminal Record Statement, LIC 501 Personnel Record, LIC 503 Health Screening/TB, LIC9052 Employee Rights, LIC9108 Statement Acknowledging Requirement to Report Child Abuse, LIC 9163 Request for LIVESCAN, LIC9188 Criminal Record Exemption Transfer Request, LIC 9182 Criminal Background Clearance Transfer Request, LIC9052 Employee Rights.

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. Applicant was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation. Applicant was provided an informational pamphlet titled, "Safe Sleep For Your Baby" during the inspection. Applicant was also provided an informational sheet titled, "What Does a Safe Sleep Environment Look Like?" to review and post at the facility.
The applicant was informed 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

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: TENG FAMILY CHILD CARE	FACILITY NUMBER: 197494458
	VISIT DATE: 09/25/2020

NARRATIVE

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LPA provided information about regulation title 22 – Title 22, Division 12
Chapter 1 - 102416.5 - Staffing Ratio and Capacity - the applicant was advised be aware of her ratio and capacity. The total licensed capacity for a Small Family Child Care Home. According to the Regulation title 22 102416.5 (b) Staffing Ratio and Capacity: For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home. Applicant understand per title 22, is required to obtained the Landlord consent to provide care for more than 12 and up 14 children (form LIC9149 Property Owner/Landlord Consent FFCH).

The following were also discussed with the licensee: Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to: 300 North Continental Blvd, El Segundo, CA 90245

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.

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.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: TENG FAMILY CHILD CARE	FACILITY NUMBER: 197494458
	VISIT DATE: 09/25/2020

NARRATIVE

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Due to the pandemic of Covid-19, LPA recommended the applicant review the following references: https://www.cdss.ca.gov/inforesources
https://www.dir.ca.gov/dosh/Coronavirus/COVID-19-Infection-Prevention-in-Childcare-Programs-Guidance.pdf
https://covid19.ca.gov
https://www.cdpr.ca.gov/docs/schoolipm/
https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html
Also, LPA Miranda, provided all forms/records to keep in her family child care home:
During this inspection, LPA also provided the following documents about SIDS. 1) A Child Care Provider’s Guide to Safe Sleep by the American Academy of Pediatrics, 2) Never ever shake a Baby by California Department of Social Services, 3) California School Immunization Record form CDPH286, 4) Car Seat – Public Health Department and 5) PUB 394 Notification of Parents Rights.
LPA obtained a copy of certificate of course completion in Child Care Lead Poisoning Prevention.
LPA Miranda recommended upon completion of the following corrections:
Documents:
LPA reviewed the earthquake disaster bag and observed missing items. Applicant will review the form LIC9148 Earthquake Preparedness checklist and complete the bag.
Applicant will obtain a permission letter from the owners of the relocation emergency disaster areas. (LIC610A)
LPA observed the Sketch Floor plan and Yard (LIC999A form), did not match with the physical premises.
OUTSIDE:
Applicant to cover the gap at the bunny’s house, that was observed.
Front yard was observed with hazard, some area with not the same level (grass area)
Front yard a cable area, that was observed, applicant will barricade this area.
Applicant to install a stair holder at the deck area, located at the front yard side.
INSIDE:
Applicant to install Latches on the cabinet’s drawers located at the kitchen area and bathroom.
Applicant will obtain a cots or mats for children
Applicant to install child proof safety knob cover on bedroom door.
Per Applicant that stated that she agreed to complete the recommendation no later than 10/02/2020.
Exit interview was conducted with Yi Chen Teng, Applicant. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

LIC809 (FAS) - (06/04)

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