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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494735
Report Date: 01/12/2021
Date Signed: 01/13/2021 08:54:25 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:KAUFMAN FAMILY CHILD CAREFACILITY NUMBER:
197494735
ADMINISTRATOR:TERESA KAUFMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 252-2621
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90278
CAPACITY:14CENSUS: 0DATE:
01/12/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:26 PM
MET WITH:Teresa KaufmanTIME COMPLETED:
04:45 PM
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On 1/12/2021 at 2:35 PM Licensing Program Analyst (LPA) Angelica Ramirez conducted a Pre-Licensing tele-inspection with applicant Teresa Kaufman via Facetime due to the current public health crisis (COVID-19). This inspection is for the purpose of relocation. Ms. Kaufman is moving from current licensed address 1819 Marshall Field Lane #1, Redondo Beach, CA 90278. The applicant guided the LPA on a virtual tour of the facility.

Areas identified on the facility sketch were inspected. This is a two story home with four bedrooms, two full bathrooms and a powder room, front yard and garage. The property has central heat only. Residing in the home is the applicant, spouse and two biological children (ages eight and two). Ms. Kaufman is currently operating a large family child care at the Marshal Field residence (license #197419752) and will be surrendering that license upon obtaining a license at the Harriman address. Ms. Kaufman provided a signed statement declaring this information to LPA Ramirez.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPA observed age appropriate safe toys. The applicant advised children will nap in the living room on cots. Applicant intends to operate Monday through Friday 7:30 AM to 6:00 PM. Applicant intends to provide meals and snacks for day care children.

The home was inspected as follows: Living room, family room (with fireplace), breakfast nook, Kitchen, four bedrooms, two bathrooms, powder room, garage, balcony (off master bedroom), play area/front yard. There is no dedicated back yard to this property, the back area of the property is a separate property with a different address.
Continued on LIC809-C
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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 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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197494735
VISIT DATE: 01/12/2021
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Areas that are accessible to children are as follows: Living room, family room, powder room (first floor) and front yard. The fireplace is missing an affixed screen, which is to be corrected prior to licensure.

Areas that are inaccessible to children are as follows: Garage, entire second floor (four bedrooms and two full baths, balcony), breakfast nook, kitchen and teachers closet (under the stairs).

Fire extinguisher (2A10BC) is up to date and was serviced on 1/4/21. Applicant has a Smoke Detector and Carbon Monoxide Detector in the family room. Tested and operating. Medications were observed to be kept away from children in the off limits master bedroom. Cleaning products are kept in the off limits teachers closet and cabinet under kitchen sink.
Facility Administration: Pediatric First Aid and CPR expires 10/28/2022 for the applicant, immunizations are on file.

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. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.
• 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.
• 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. The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
• 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.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197494735
VISIT DATE: 01/12/2021
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• The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
• Changes should be reported the to the Department as soon as they occur such as construction and remodeling
• Telephone number changes and/or if you move from home
• Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
• Fire and safety drills must be performed every six months and documented for review by the Department.
• There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
• Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
• Saucer chairs, bouncers, walkers, or any similar items are prohibited.
• All adults living and working in the home shall be made of 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.
• Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
• LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

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 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: childcareadvocatesprogram@dss.ca.gov

AB 1207: Beginning on January 1, 2018, this law 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
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197494735
VISIT DATE: 01/12/2021
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Update on Incidental Medical Services (IMS):
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.

IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.
Incidental Medical Services (IMS) policy was discussed. For further IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
Currently, the facility does not provide Incidental Medical Services - IMS.

SIDS & SHAKEN BABY SYNDROME INFORMATION discussed.
Safe Sleep Practices were also discussed with the applicant. When putting infants down for naps or long periods of sleep, the children must be placed on their backs, in a crib, on a firm mattress with nothing in the crib except for a fitted sheet over the mattress. The child should be physically monitored every 15 minutes along with their temperatures, color of skin, and breathing.

LPA discussed with applicant the process of childcare during a pandemic. LPA discussed with applicant facial coverings in day care, physical distancing, hand washing hygiene, postings, and cleaning and disinfecting of surfaces and high traffic areas. LPA advised children should follow physical distancing when indoors. LPA discussed isolation area with applicant when children are sick, children to be placed in the art area which is located off the family room (sliding door) while parents arrive. LPA discussed the importance and process of health screenings for children and staff upon arrival to the facility.

LPA also provided postings regarding COVID-19 and the Guidance for Early Childhood Education documentation. The COVID-19 Self-Assessment Guide was also provided to the applicant along with the Decisions Pathway for children and adults.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197494735
VISIT DATE: 01/12/2021
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 Children’s records requirements:
• LIC 700 Identification and Emergency Information
• LIC 627 Consent for Emergency Medical Treatment
• LIC 282 Affidavit Regarding Liability Insurance
• LIC 9150 Parent Notification Additional Children in Care
• Immunization record
• PUB 72- Family Child Care Consumer Guide
• LIC 995A Notification of Parent’s Rights

FACILITY RECORDS:
• LIC 624B Unusual Incident/Injury Report
• LIC 9040 Child Care Facility Roster
• LIC 9052 Employee Rights
• LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
• LIC 9149 Property Owner/Landlord Consent Form
• LIC 9151 Property Owner/Landlord Notification Form
• Proof of current pediatric CPR and First Aid Certificates
• Copy of your deed or lease/rental agreement
• Documentation of Fire and Disaster drills
• Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
• Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years

FORMS TO BE POSTED
• LIC203 Facility License
• LIC 610A Emergency Disaster Plan
• LIC 9148 Earthquake Preparedness Checklist
• PUB394 Notification of Parents Rights Poster

A complete packet that includes the documents listed above, as well as a ratio flyer, Effects of Lead exposure, PIN 19-02 on Safe Sleep, PIN 19-18 Emergency Disaster, Never Shake a Baby flyer, were emailed to and discussed with the applicant during this inspection.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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: KAUFMAN FAMILY CHILD CARE
FACILITY NUMBER: 197494735
VISIT DATE: 01/12/2021
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  • The following items are pending prior to licensure to be completed by 1/27/21.
  • Affixed screen needed on fireplace in family room
  • Add latches on cabinets under kitchen sink and cabinet where knives stored, also to cabinets under powder room sink
  • Add child proof knobs to stove/range
  • Case for weapons and ammunition must be locked and applicant must advise LPA of the permanent location

Prior to issuing a license, LPA Ramirez will conduct a follow up inspection to review the permanent location of the weapon and ammunition as well as locks.

Applicant intends to surrender her license from Marshal Field Lane on 1/29/2021 and will be dropped off at the El Segundo Child Care Office.

Exit interview was conducted with Ms. Kaufman. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

A copy of this report was emailed to the applicant and it has been explained that a reply to this email shall be considered a substitute for the hard-copy signature.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
LIC809 (FAS) - (06/04)
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