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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000680
Report Date: 07/18/2022
Date Signed: 07/18/2022 12:41:34 PM


Document Has Been Signed on 07/18/2022 12:41 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:ABERCROMBIE FAMILY DAY CAREFACILITY NUMBER:
198000680
ADMINISTRATOR:ABERCROMBIE, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 400-0289
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:12CENSUS: 2DATE:
07/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee - Sylvia AbercrombieTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required one year inspection to the above facility on 07/18/22. LPA arrived at the facility at 9:30 AM and met with licensee, Sylvia Abercrombie, who guided analyst on a tour of the facility. Also present during this inspection was S2 and S3. Per Licensee, there are 2 children that are currently enrolled. There were 2 children present upon arrival.

This is a one-story home which consists of three bedrooms, two bathrooms, kitchen/dining room, living room, den, a detached garage, front yard and backyard (fenced). The off limit areas include three bedrooms, one bathroom, kitchen/dining area, front yard, and detached garage.

The main care area is located at the back of the home in the den. Per licensee, parent pick up and drop off occurs on the side door attached to the gate leading to the backyard area. LPA observed age appropriate toys and materials, a baby changing station, two pack and play playpens, child sized tables, child sized chairs, and a children's locker for personal belongings. LPA observed an infant in a walker. LPA advised that a citation under California Code of Regulation (CCR) Section 102417(g)(10) will be issued. LPA observed the bathroom designated for children in care to be clean and free of defects. LPA observed cleaning supplies stored beneath the cabinet sink without a lock. LPA advised that a citation under CCR Section 102417(g)(4) will be issued. The outdoor play area is located in the backyard and observed with perimeter fencing. LPA observed children's outdoor play equipment and an off-limits detached garage in the backyard. A vehicle was also observed in the backyard and surrounded with plants. Per licensee, the car works but it is not used. LPA observed the car to be inaccessible to children in care. LPA observed an uncovered barbecue grill, an uncovered propane heating lamp, and and uncovered wood fire stove in the backyard play area. LPA also observed dog feces in the backyard play area. LPA advised that a citation under CCR Section 102417(g) will be issued. The licensee states that she provides food for children in care. LPA observed facility license and parents rights poster (PUB 394) posted in the main care area. Per licensee, she did not have an emergency disaster plan (LIC 610A) posted. LPA advised that a citation under CCR Section (page 1 of 3)
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
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 14


Document Has Been Signed on 07/18/2022 12:41 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: ABERCROMBIE FAMILY DAY CARE
FACILITY NUMBER: 198000680

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2022
Plan of Correction
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Licensee states she will either cover or remove heating lamp, wood fire stove and barbecue grill from outdoor play area. Licensee also states she will remove dog feces from outdoor play area prior to children playing outside. LPA advised that a case management visit will be required to observed corrections
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2022
Plan of Correction
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Licensee states she will lock cabinet under sink to make contents inaccessible. LPA advised that a case management visit will be required to review corrections.

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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 14


Document Has Been Signed on 07/18/2022 12:41 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: ABERCROMBIE FAMILY DAY CARE
FACILITY NUMBER: 198000680

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2022
Plan of Correction
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Licensee states she will complete and post emergency disaster plan (LIC 610A). LPA advised that a case manage visit will be required to observe the corrections.
Type B
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2022
Plan of Correction
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Licensee states she will get rid of infant walker. LPA advised that a case management visit will be required to observe the corrections.

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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 14


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: ABERCROMBIE FAMILY DAY CARE
FACILITY NUMBER: 198000680
VISIT DATE: 07/18/2022
NARRATIVE
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102417(g)(9) will be issued. No bodies of water were observed in the back yard play area. LPA observed 4 pet dogs kept in the off-limit area of the home. The off limit areas of the home and the main care area are separated by two doors. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Individuals who reside in the home were noted and discussed. Licensee was reminded that all adults 18 and over, 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 Child Care Center. 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. Licensee states that there are no firearms stored in the home. There is telephone service via a land line. Per Licensee, the home is equipped with central heating and air conditioning.

Per licensee, detergents, cleaning compounds, and other items which could pose a danger to children are kept in the cabinet of the off limits kitchen. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked, not just inaccessible. The restroom that children use was observed to be safe and sanitary. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 04/28/22, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.



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.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 06/2023. LPA observed that the Licensee has proof of Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. Per licensee, she has not had children in care since 01/2022. She also states that current children in care are her grandchildren, however (page 2 of 3)

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC809 (FAS) - (06/04)
Page: 13 of 14
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: ABERCROMBIE FAMILY DAY CARE
FACILITY NUMBER: 198000680
VISIT DATE: 07/18/2022
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she is open to accept additional children into care. LPA advised that technical violations will be issued with regards to children's files maintenance and maintaining an updated roster.

Incidental Medical Services (IMS):
IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov. LPA also discussed and provided the Provider Information Notices (PINS) on Recently Approved Safe Sleep Regulations in Effect: PIN 20-24-CCP, Child Care Facility Roster: LIC 9040, Individual Infant Sleep Plan - LIC 9227, Infant Sleep Chart, and Children's File Checklist. LPA advised that infant sleep chart and children's file checklist are not resources and cannot be found on the CDSS website.

The following deficiencies listed on the attached LIC 809 (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.

Exit interview conducted, appeal rights provided and report was reviewed with the licensee Sylvia Abercrombie.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC809 (FAS) - (06/04)
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