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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001806
Report Date: 03/03/2022
Date Signed: 03/03/2022 11:31:15 AM


Document Has Been Signed on 03/03/2022 11:31 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:FORD FAMILY CHILD CAREFACILITY NUMBER:
198001806
ADMINISTRATOR:YOUNG-FORD, LOUELLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 762-6033
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:14CENSUS: 1DATE:
03/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Louella FOrd, LicenseeTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced required 1 year inspection to the above facility on 03/03/22. LPA arrived at the facility at 8:40AM, identified self and met with Louella Ford, Licensee, who guided analyst on a tour of the facility. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. LPA observed that also present during this inspection, was 2nd Licensee, Kenneth Ford, Duryea Cahee, Krystal Ford, and Jaylan Wade. LPA informed Licensees that Jaylan Wade is not associated to the facility. At 9:29AM LPA called the regional office to confirm that Jaylan Wade is not associated to facility. A civil penalty of $100 is being assessed during today's visit. LPA observed one child upon arrival. Per Licensee, operation hours are 6AM to 6PM. Per Licensees, there are 14 children that are currently enrolled. A current children’s roster was available for review.

This is a two-story home which consists of 5 bedrooms, 2 bathrooms, kitchen, dining room, living room, laundry area, den, front yard and backyard (fenced). The children use the bathroom in the hallway close to the den. LPA observed that there is a fireplace in the dining room and it is screened. Per Licensees, areas off limits to children and parents include: all of upstairs, all bedrooms, living room, dining room, kitchen, laundry area, front yard. The licensee provides food for children in care.

Individuals who reside in the home were noted and discussed.

Licensee was reminded that all adults 18 and over living or working in the home, 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.
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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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: FORD FAMILY CHILD CARE
FACILITY NUMBER: 198001806
VISIT DATE: 03/03/2022
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Licensee states that there are no firearms stored in the home.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. LPA advised Licensee to submit an updated skecth to reflect the upstairs area. There is telephone service via a landline and cellphone that is used. There is ventilation and heating. Safe toys play equipment and materials were observed.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. Per Licensee, there are no poisons stored at the facility and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A 10BC fire extinguisher indicates fully charged, however, LPA did not observe a service tag or receipt. Licensee called the store where extinguisher was purchased and is pending a copy or invoice to show the date it was purchased. LPA advised that the fire extinguishers need to have a Fire Marshal tag or a receipt to show when it was serviced or purchased. Smoke and carbon monoxide detectors were tested to ensure that they are operable.

Licensee states that she is not currently caring for infants. Licensee states that if an infant is enrolled, the infant will sleep in the den where they are constantly supervised. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. Licenseee was advised to read Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect. LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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. ----Page 2 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
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: FORD FAMILY CHILD CARE
FACILITY NUMBER: 198001806
VISIT DATE: 03/03/2022
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Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. 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 a danger to children on the outdoor yard. The licensee states that supervision is always provided.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 01/10/23. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children.

Children’s records were reviewed, including emergency information and were observed to be complete.

The licensee does have proof of immunization against influenza, pertussis, and measles. LPA observed that the Licensees do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Licensee was able to provide several fire drill logs during the inspection due to their local child care agency requiring monthly drills but was unable to find their 2022 logs during the inspection. LPA advised that they submit a copy of their most recent.

There are no pets on the premises. LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.-----Page 3 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: FORD FAMILY CHILD CARE
FACILITY NUMBER: 198001806
VISIT DATE: 03/03/2022
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Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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.

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

The following deficiency listed on the attached 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. LPA: add if a type a deficiency is cited

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

Exit interview conducted and report was reviewed with the licensee Louella Ford.

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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 03/03/2022 11:31 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: FORD FAMILY CHILD CARE
FACILITY NUMBER: 198001806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102370(d)(2)
102370(d)(2) Criminal Record Clearance
(d) All individuals subject to a criminal record review ....
(2) Request a transfer of a criminal record clearance...

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 due to having Jaylan Wade present in the home when children are in care and they are not associated to the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/04/2022
Plan of Correction
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Per Licensee, they will associate Jaylan Wade by POC due date.
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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5