197494594-10-9-2020-30-CC-JLAO-BU8LSU-20201009090116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494594
Report Date: 10/08/2020
Date Signed: 10/09/2020 09:01:31 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:	JOHNSON FAMILY CHILD CARE		FACILITY NUMBER:	197494594
ADMINISTRATOR:	TIFFANY JOHNSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 213-2808
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	14	CENSUS:	DATE:	10/08/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:26 AM
MET WITH:	Tiffany Johnson		TIME COMPLETED:	11:27 PM

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 10/08/2020 at 8:30 am Licensing Program Analyst (LPA) Judy Laureano and Licensing Program Manager (LPM) Victor Bautista conducted a Tele Visit through Zoom with Applicant, Tiffany Johnson for the purpose of a pre-licensing inspection of property 11714 Truro Avenue #A, Hawthorne, CA 90250. The purpose of this pre-licensing visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes. The applicant currently operates a Large Family Child Care Home, Facility 197417184. The applicant is applying for a change of location from license number 197417184 to this current location:11714 Truro Avenue #A, Hawthorne, CA 90250. The change of location is for a Large Family Child Care license with a max capacity of 14. A fire clearance was approved by LA County Fire Department and received at CCL on 9/25/2020. LA County Fire Department signed and dated clearance on 9/16/2020 The applicant rent/leases the property with minor child Brennan Minor. Landlord consent was received with a copy of the rent/lease agreement. Applicant, Tiffany Johnson, has an adult daughter that does reside in the home. LPA Laureano advised applicant to get her adult daughter finger printed prior to her being at the home. The capacity of the Large Family Child Care Home is 14. Per the application, at this time, the ages the applicant wishes to provide services for are children 4 months old to 12 years old with the hours of operation are 24 hours which indicates that she is available for overnight care. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes. Page 1

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 197494594
	VISIT DATE: 10/08/2020

NARRATIVE

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The structure is a two-story home with 2 bedrooms and 1 bathroom that are located upstairs which are inaccessible to the children with a child safety gate in the bottom of the stair way. The first floor has 1 bedroom, 1 bathroom, 1 bedroom/1day care room, living room, kitchen, office and laundry room. Applicant toured LPA Laureano and LPM Bautista via zoom tele visit through the residence and the grounds. LPA Laureano and LPM Bautista observed the front yard with a gate that latches where children will enter the facility. The front yard is fenced and enclosed. The lot has an additional unit in the back, unit b, that has it's own private entry way.

Outdoor Area/Front Yard: LPA Laureano and LPM Bautista observed the front yard where applicant has designated two different area for use. The area is covered with green turf and wood chips along the perimeter. LPA Laureano and LPM Bautista observed age appropriate toys where children ages 2 and older will be using. The second area is covered with a canopy and includes 2 picnic style children’s table and different chairs for facility to use. LPA Laureano and LPM Bautista observed a BBQ grill that is covered and away from the tables and chairs

LPA Laureano and LPM Bautista observed the main entrance of the facility that included information for parents to read. Upon entering the facility, children’s cubbies are on the left-hand side with a parent board. Fire extinguisher, first aid kit and alarm is located by the entry way. Immediately to the left you are led to the first room that is dedicated to the daycare. Age appropriate toys and materials were observed. Materials included Dramatic play area, Quiet Area, Puppet area, a highchair and a children's size table where children will work. LPA Laureano and LPM Baustista observed a camera and carbon monoxide alarm and smoke detector in the room. Applicant states that the camera is motion sensitive, live action and clips are only archived for a few hours and is only active when alarm is engaged.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

LIC809 (FAS) - (06/04)

Page: 2 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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 197494594
	VISIT DATE: 10/08/2020

NARRATIVE

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A small hallway to the left of day care room LPA Laureano and LPM Bautista observed a changing table with gloves, diapers. LPA Laureano and LPM Bautista observed applicant demonstrate her diapering changing procedures. Applicant was observed having both the bathroom sink and a waste basket with a lid available to dispose and clean after diapering. The changing table is propped against a door that leads to a storage closet. Storage closet is not being used and door handle has been removed as a safety precaution which makes it inaccessible to the children. LPA Laureano and LPM Bautista observed the applicant open the closet to inspect the content and observed nothing that is considered hazardous.

As you continue down the hallway, bedroom 1 was observed and has been designated as an off-limit area and will remain locked which makes it inaccessible to children in care. At the end of the hallway LPA Laureano and LPM Bautista observed a bathroom that children will used. LPA Laureano and LPM Bautista observed a working sink with hot water turned off. Applicant was advised to purchase a thermometer to take the temperature of the hot water to ensure water temperature is suitable for the children in care. LPA Laureano and LPM Bautista observed a toilet, a sink with cabinets that store baby wipes and extra toilet paper. All drawers and cabinets have safety latches on

Kitchen area is located to the right of the entry way. LPA Laureano and LPM Bautista observed a safety gate in the entryway of the kitchen making inaccessible to the children. LPA Laureano advised applicant to add safety latches to the kitchen cabinets in case safety gate is not closed properly, an added safety precaution.
The stove, refrigerator, sink and counter space area where observed and inspected. A fire extinguisher can be found by the stove.

Outside the kitchen, LPA Laureano and LPM Bautista observed the living room area that applicant has designated as a secondary day care room. Age appropriate materials were observed including two child size tables.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

LIC809 (FAS) - (06/04)

Page: 3 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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 197494594
	VISIT DATE: 10/08/2020

NARRATIVE

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A fire place with a metal cover, a fire extinguisher and a second camera were observed. The living room leads you to a sliding door where applicant has designated as an office space. LPA Laureano and LPM Bautista observed a black locked cabinet that is designated to store children’s file. The sliding door has a latch and is easily accessible in case of an emergency. The sliding door has an exit sign for evacuation. At the end of the office, you are led to the laundry room. Both of these room are inaccessible to the children.

To the left of the sliding doors, stairs are available that lead you to the upstairs, the stairs have been made inaccessible to the children with a safety gate and applicant has covered the entry way. As you go upstairs, to the left LPA Laureano and LPM Bautista observed one bedroom, right outside the bedroom is an area with cabinets and a small hallway that leads you to the bathroom. Outside the bathroom, to the right LPA Laureano and LBM Bautista observed the second bedroom. LPA Laureano and LPM Bautista advised applicant that all doors in the upstairs area need to remain closed during the operating hours of the program.

The applicant submitted pictures indicating all kitchen cabinets have safety latches and the door knob for the bedroom in the first floor has been changed to a knob that requires a key.

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

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare 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 Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 197494594
	VISIT DATE: 10/08/2020

NARRATIVE

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Mandated Reporter Training: 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. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse. Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home. Applicant was reminded that all documents for children's records must be kept current, as well as the roster and Drill Log additional forms can be obtained from the Department website: www.ccld.ca.gov

Applicant was reminded that it is the licensee's, as well as anyone who assists in providing care's, responsibility to know the regulations. Applicant was informed how to access quarterly report, forms and regulations for Child Care online at www.ccld.ca.gov Applicant was also encouraged to read the Child Care quarterly updates.

Reporting requirements: Applicant must report an incident to the Child Care Regional office by telephone within 24 hours and in writing within 7 days.

Safe Sleep Links:

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
Safe sleep for your baby pamphlet and what does safe sleep look like wall flyer provided to applicant. Safe Sleep new flyer (5/23/2019) also given to applicant

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 197494594
	VISIT DATE: 10/08/2020

NARRATIVE

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SIDS & SHAKEN BABY SYNDROME INFORMATION: LPA discussed safe sleep for infants with applicant: Infants must be placed on their backs and must be physically checked every 15 minutes to gauge temperature and ensure they are breathing. Applicant reviewed both items provided and understands the guidance of safe sleep practices. LPA discussed flyer given today (Never Shake a Baby) Applicant reviewed flyer and understands the preventive practices of shaken baby syndrome and abusive head trauma.

Based on LPA Laureano's observation and discussion with LPM Bautista, applicant meet Tlttle 22 requirements in order to obtain a license.

This license shall be granted for October 12, 2020. Facility # 197417184 shall be closed October 11th, 2020.

LPA Laureano and LPM Bautista completed the televisit with applicant Tiffany Johson from 8:30 to 9:30 am.
LPA Laureano resumed communication with applicant at 3:30 pm to clarify some additional information and review the report.

An exit interview was conducted over the phone and a copy of this report was provided to the applicant TIffany Johnson via email.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

LIC809 (FAS) - (06/04)

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