198000603-9-30-2022-54-CC-MAYA-CJRQC5-20220930120233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198000603
Report Date: 09/30/2022
Date Signed: 09/30/2022 12:02:52 PM

Document Has Been Signed on 09/30/2022 12:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	DENNIS, SANDRA FAMILY DAY CARE		FACILITY NUMBER:	198000603
ADMINISTRATOR:	DENNIS, SANDRA ANN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 422-3432
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY:	14	CENSUS: 8	DATE:	09/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee, Sandra Dennis		TIME COMPLETED:	12:15 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 September 30, 2022 at 9:00 AM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Sandra Dennis. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 7:00 AM to 6:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, the Licensee, two (2) staff, and eight (8) children were present. All areas identified on the facility sketch were inspected. This facility is a single family home that consists of four (4) bedrooms, 2 bathrooms, kitchen, dining room, laundry room, living room, child care room, detached garage, and fenced backyard. Areas that are accessible to children include: one (1) bedroom, 1 bathroom, kitchen, dining room, laundry room, living room, day care room, and fenced backyard. Per Licensee, the children utilize the fenced backyard for outdoor activity. Areas off-limits to children include: three (3) bedrooms, 1 bathroom, and detached garage. LPA observed the doors that allow access to the off-limit bedrooms and 1 bathroom, closed and locked, making the off-limit areas inaccessible to children in care. The Licensee was advised that off-limit areas must be made inaccessible during operating hours. The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness (LIC 9148). The Licensee has verification of disaster and fire drills available for review. The last drill was conducted on September 25, 2022. The Licensee also has a current Facility Roster (LIC 9040) available for review.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DENNIS, SANDRA FAMILY DAY CARE	FACILITY NUMBER: 198000603
	VISIT DATE: 09/30/2022

NARRATIVE

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Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. LPA did not observe any wall heaters in the home. The home has central air and heating. LPA observed a fireplace in the child care room that is barricaded and not operable. Detergents, cleaning compounds and medicines were made inaccessible to children in care. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock. Per Licensee, there are no bodies of water, firearms and/or weapons on the premises. The Licensee has a dog that is kept isolated from the children in care. LPA observed age appropriate toys and napping equipment for children. LPA observed electrical outlet covers installed in the child care areas.

LPA observed the required fire extinguisher (2A-10BC) that is fully charged and was last serviced on August 3, 2022. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detector was tested and is operable. Licensee did not have an operable carbon monoxide detector but showed LPA proof that a new carbon monoxide detector is being delivered to the facility today. First Aid kit and emergency supplies are available and kept in the hallway closet near the main entrance. Licensee stated that she provides breakfast, lunch and PM snack to the children. Licensee was reminded that food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review of 8 children's records, Licensee's record, and 2 personnel records (S1 and S2). Based on the children's record review, child (C1) and C8 did not have a sleep log for the 15-minute physical checks available for review. Based on the personnel record review, staff (S1) did not have immunization against pertussis available for review, and S2 did not have a current Mandated Reporter (AB 1207) training certificate and TB clearance available for review.

Licensee has proof of immunization against measles, pertussis, influenza, and a TB clearance. Licensee has a valid Pediatric First Aid and CPR certification (expires July 2023). Licensee completed the required Preventative Health and Safety Practices on December 8, 1994 and Mandated Reporter Training (AB 1207) on August 6, 2021. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DENNIS, SANDRA FAMILY DAY CARE	FACILITY NUMBER: 198000603
	VISIT DATE: 09/30/2022

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.

Incidental Medical Services (IMS) policy was discussed. For 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

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platforms.

LPA provided assistance to the Licensee on how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DENNIS, SANDRA FAMILY DAY CARE	FACILITY NUMBER: 198000603
	VISIT DATE: 09/30/2022

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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/inspection-process.

Deficiencies were cited during today's inspection (refer to deficiency pages).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Sandra Dennis. Appeal rights were explained and provided to the facility representative.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/30/2022 12:02 PM - 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DENNIS, SANDRA FAMILY DAY CARE	FACILITY NUMBER: 198000603
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/30/2022

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 personnel record (S2) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/31/2022
	Plan of Correction
1 2 3 4	Licensee will submit the certificate of completion for the required Mandated Reporter Training (AB 1207) for staff (S2) via e-mail to LPA by October 31st.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 personnel records (S1 and S2) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/31/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of immunization against pertussis or documentation of exemption for S1, and TB clearance or risk assessment for S2 to LPA via e-mail by October 31st.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC809 (FAS) - (06/04)

Page: 5 of 7

Document Has Been Signed on 09/30/2022 12:02 PM - 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DENNIS, SANDRA FAMILY DAY CARE	FACILITY NUMBER: 198000603
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 children's records (C1 and C8) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/31/2022
	Plan of Correction
1 2 3 4	Licensee will submit a napping log for at least one week, documentating the 15-minute physical checks for C1 and C8 to LPA via e-mail by October 31st.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC809 (FAS) - (06/04)

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