198002034-6-23-2022-54-CC-MAYA-CFNR5Y-20220623124354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198002034
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:44:09 PM

Document Has Been Signed on 06/23/2022 12:44 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:	GLENN,NORMA FAMILY DAY CARE		FACILITY NUMBER:	198002034
ADMINISTRATOR:	GLENN, NORMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 420-1315
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90713
CAPACITY:	14	CENSUS: 3	DATE:	06/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Licensee, Norma Glenn		TIME COMPLETED:	12:50 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 06/23/2022 at 10:05 am Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Norma Glenn. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 6:00 AM to 5:30 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, 3 children were present. Per Licensee, she does not have a dual license at this address. All areas identified on the facility sketch were inspected. This facility is a single family home that consists of two (2) bedrooms, two (2) bathrooms, living room, dining room, family room, kitchen, laundry room (next to kitchen), detached garage, workshop, and fenced backyard. Areas that are accessible to children include: the living room, dining room, kitchen, laundry room, 1 bathroom, and backyard (fenced). Per Licensee, the children utilize the backyard (fenced) for outdoor activity. Areas off-limits to children include: 2 bedrooms, 1 bathroom, family room, detached garage, workshop, and a portion of the backyard where the workshop is located. LPA observed the bedroom doors closed, locked and child safety knobs placed on the bedroom doors to prevent access to areas that are off-limits to children. LPA observed the door leading to the family room, closed, locked and having a child safety knob placed on the family room door making the area and 1 bathroom inaccessible to children in care. LPA observed the garage door closed and locked making the area inaccessible to children. LPA also observed a gate located in the backyard that was closed, locked, and having a child safety knob to prevent access to part of the backyard and workshop that is off-limits to children. The Licensee was advised that off-limit areas must be made inaccessible during operating hours. Page 1

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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 4

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: GLENN,NORMA FAMILY DAY CARE	FACILITY NUMBER: 198002034
	VISIT DATE: 06/23/2022

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
26
27
28
29
30
31
32

The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), Earthquake Preparedness (LIC 9148), Emergency Disaster Plan (LIC 610A), Verification of Disaster and Fire Drills, and COVID-19 related posters.

Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The facility has central air and heating. The home does not have a fireplace or any wall heaters. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are made inaccessible. 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 firearms, weapons or bodies of water on the premises. LPA observed a water fountain located in the front yard. The water fountain was empty and did not contain any water. The water fountain is located in a gated area that is inaccessible to children in care. Licensee has 3 dogs and birds that are isolated from children in care.

LPA observed age appropriate toys and napping equipment for children. LPA observed electrical outlet covers throughout the home. LPA observed the required fire extinguisher (2A-10BC) that is fully charged. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke and carbon monoxide detectors were tested and are operable. First Aid kits and emergency supplies are available and located throughout the home.

Licensee stated that she provides snacks and meals to children. Per Licensee, children do not bring food from home. Licensee was informed that if food is brought from the child's home it shall be labeled with the child’s name and properly stored or refrigerated.

Licensee has a current Pediatric First Aid and CPR certification (EMSA-approved, expires 10/2023). Licensee has proof of immunization against measles and pertussis. Licensee has a decline declaration for influenza on record. Licensee completed the Preventative Health and Safety with Nutrition training on 07/30/2017. Licensee completed the Mandated Reporter (AB 1207) training on 06/14/2020. Per Licensee, the Mandated Reporter (AB 1207) training will be completed again by the end of June 2022. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.
Page 2

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: GLENN,NORMA FAMILY DAY CARE	FACILITY NUMBER: 198002034
	VISIT DATE: 06/23/2022

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
26
27
28
29
30
31
32

LPA conducted a record review of 3 children's files. Based on the file review, the children's records were complete and contained all of the required documents per Title 22 regulations, including the Individual Infant Sleep Plan (LIC 9227) and documentation for the 15 minute physical checks for sleeping infants.

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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.
Page 3

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: GLENN,NORMA FAMILY DAY CARE	FACILITY NUMBER: 198002034
	VISIT DATE: 06/23/2022

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
26
27
28
29
30
31
32

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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.

LPA requested that copies of the following documents be submitted to the Monterey Park Child Care Regional Office located at 1000 Corporate Center Dr., Suite 200B, Monterey Park, CA 91754 by Friday, July 8th: an updated Application for a Family Child Care Home License (LIC 279), Current Children in Your Home (LIC 279B), Criminal Record Statement (LIC 508) for all adults in the home, TB clearance or TB Risk Assessment for all adults in the home, Immunization Record (measles, pertussis, and influenza) for Licensee, Pediatric First Aid/CPR Certificate for Licensee, Preventative Health and Safety Certificate for Licensee, Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) for Licensee, Mandated Reporter (AB 1207) Certificate for Licensee, Facility Sketch (LIC 999A), Emergency Disaster Plan (LIC 610A), and proof of control of property (deed, tax bill, or mortgage bill).

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

Exit interview conducted and report was reviewed with Licensee, Norma Glenn.

Page 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4