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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494469
Report Date: 01/04/2024
Date Signed: 01/04/2024 11:09:32 AM


Document Has Been Signed on 01/04/2024 11:09 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:EISEN FAMILY CHILD CAREFACILITY NUMBER:
197494469
ADMINISTRATOR:EISEN, SARAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(201) 640-1900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY:14CENSUS: 11DATE:
01/04/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sarah Eisen TIME COMPLETED:
11:20 AM
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At 01/04/2024, 8:30 am Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced required 3-year inspection to the above facility. A COVID risk assessment was conducted upon entry. LPA met with Licensee, Sarah Eisen to whom the reason for the visit was explained. Per Licensee, there are 11 children currently enrolled. There were 6 children present then 5 more came in and licensees’ assistant Deena Lichtman was present upon arrival. Licenses Husband came in right after and guided LPA to the tour of the home . The licensee was observed to be operating within the license capacity limitations.

The licensee states that 2 adults and 6 children currently live in the home. All adults living in the home have obtained a criminal record clearance. LPA obtained updated LIC 279B from the licensee.
This is a one-story home which consists of 3 bedrooms, 2 bathrooms, living room, dining room, kitchen, detached garage, and backyard which is gated .
Care is provided in the living room, dining room, 1 bathroom , backyard, detached garage and children’s bedroom used to isolate ill child , if necessary. Per licensee parents enter the home through the main entrance which leads directly to the living room.
Per licensee, areas off limits to children and parents include licensee’s bedroom , bathroom .

During this visit, all areas identified that are accessible for children to use were inspected for the safety, comfort, and cleanliness. At 08:45 am LPA toured the home starting from the living room where observed sofa and children’s chairs .LPA toured dinning room where observed bookcase and dinning table with chairs .Next LPA toured the kitchen where observed latches on the drawers where cleaning compounds and sharp items located . Children use bathroom located in the hallway where LPA did not observe anything dangerous for the children .End of the hallway Licensees children bedroom where LPA observed beds and 2 cribs , per licensee it is only used to isolate ill child and beds are used for their own kids . Through the kitchen children exit to the backyard where LPA observed age-appropriate toys and tricycles , LPA observed trampoline with the net on the grass part of the backyard and reminded licensee children needs to be supervised all the time and Licensee needs to follow to all the instructions on the trampoline manual . Declaration obtained . Per licensee garage is used for the activities for the short period of time , LPA observed storage filled with toys and activity supplies for the kids .
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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024
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 7


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EISEN FAMILY CHILD CARE
FACILITY NUMBER: 197494469
VISIT DATE: 01/04/2024
NARRATIVE
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Facility License, Emergency Disaster Plan, Parent’s Rights Poster, and Earthquake Preparedness Checklist were observed to be posted in the living room wall . A current children’s roster was available for review.

There is telephone service via a cellphone that stays at the facility during operation hours. Hours of operation are Monday – Thursday , 08:30 am – 02:30 pm , Friday ends at 12:00pm . Per licensee due to the part time program children don’t nap . There is central air and heating in the home.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons in the home. LPA advised that any poisons should be locked under key or combination lock. Licensee states that there are no firearms or weapons stored in the home.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and located in the kitchen , Licensee was able to provide receipt with date 01/04/2023.Smoke and carbon monoxide detectors were tested in the hallway and the garage and are operable.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 12/08/23.
.The home is observed to be clean and orderly. There are first aid supplies available. There are age-appropriate toys available for children.

Per licensee, she does not provide food for children in care. Children bring their own food and pm snack from home . Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. LPA observed children’s backpacks in the kitchen with their lunch and water bottles.
Currently, children are using the backyard for outdoor play time. The outdoor play area was observed to be gated. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose danger to children. No bodies of water were observed on this day.

At 09:15 am Licensee and staff records were reviewed. The licensee has completed training on preventive health practices including CPR, certificate expires 12/09/2025 , but was not able to provide proof for the First Aid.
LPA observed that the Licensee does have proof of Mandated Reporter AB 1207 compliant Child Care Training Certificate on file with expiration on 12/19/2025. Licensees Assistant certificate expires 12/25/2025.
Second Assistant did not take the mandated reporter training . LPA reminded licensee that all the staff members required to take Mandated Reporter Training and renew every 2 years , website provided www.mandatedreporterca.com .
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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EISEN FAMILY CHILD CARE
FACILITY NUMBER: 197494469
VISIT DATE: 01/04/2024
NARRATIVE
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At 09:25 am, LPA observed that Licensee`s Assistant is missing proof of Measles immunization. Other assistant is missing Mandated Reporter Training and immunization's . Per licensee , assistants have an immunization , but were not able to present during the inspection .

At 09:30 am children’s records were reviewed, including emergency information, and were observed to be complete. LPA discussed with licensee, that all the files need to have all the required forms with all necessary information . All the sections on the forms needs to be completed . Licensee states she is currently not caring for any infants.

LPA created an LIC 857, Children’s Record Review, and LIC 811 Staff Record Review which documents staff and children’s files reviewed during this inspection.

Per licensee, there are no animals on the premises.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family childcare facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EISEN FAMILY CHILD CARE
FACILITY NUMBER: 197494469
VISIT DATE: 01/04/2024
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California

During the exit interview, the LICENSEE Sarah Eisen , confirmed that there are no Registered Sex Offenders living in the facility .

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.



A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 01/04/2024 11:09 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: EISEN FAMILY CHILD CARE
FACILITY NUMBER: 197494469

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 3 total counts staff member did not complete mandated reporter training , which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/11/2024
Plan of Correction
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Per licensee assistant will complete the training and will email the certificate to the LPA by POC date .
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review , the licensee did not comply with the section cited above and did not have First Aid training completed , which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/18/2024
Plan of Correction
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Per Licensee , she will enroll into the training and will email proof of enrollement by POC date and then will email completed certificate to the LPA .
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 01/04/2024 11:09 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: EISEN FAMILY CHILD CARE
FACILITY NUMBER: 197494469

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, interview and record review , the licensee did not comply with the section cited above and was unable to provide the proof of immunizations for the 2 assistants , which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/18/2024
Plan of Correction
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Licensee will email proof of immunizations for assistant 1 and assistant 2 by POC date to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7