198002164-8-25-2023-54-CC-WBIS-CV2PQU-20230825113139

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198002164
Report Date: 08/25/2023
Date Signed: 08/25/2023 11:32:22 AM

Document Has Been Signed on 08/25/2023 11:32 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:	DOUGLASS, MARIA & JOHN FAMILY DAY CARE		FACILITY NUMBER:	198002164
ADMINISTRATOR:	DOUGLASS, MARIA & JOHN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 596-2456
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	14	CENSUS: 6	DATE:	08/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Maria Douglass		TIME COMPLETED:	11:45 AM

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	Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required 1 Year inspection. LPA met with Licensee Maria Douglass and John Douglass who guided LPA on a tour of the facility. Licensees were caring for seven children (three preschool and four infants). There are no school age children at this time. LPA informed Licensees that the license reverts back to Small Family child care ratio requirements when there is no assistant available. All residents associated with the facility were noted. At 9:30am all areas identified on the facility sketch were inspected. This is a one story home which consists of four bedrooms and two bathrooms. Areas used by the children include the living room, dining room, infant nap room, one restroom, and the back yard. Per Licensee, areas off limits to children and parents include: garage, two bedrooms, one bathroom. LPA informed Licensees to always ensure that hazards (medicines, sharp objects, chemicals, cleaners, lotions, etc) are inaccessible to children at all times. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. Between 9:30am and 9:50 am LPA observed age appropriate toys and equipment inside the home and the backyard. The backyard is surrounded by fencing approximately 5 feet high. There is a working phone maintained in the home. There is one medium size accessible dog on the premises. LPA advised Licensee to provide extra care and supervision with accessible pets because animals can be unpredictable. LPA observed detergents, cleaning compounds, which can pose a danger to children to be inaccessible (in locked kitchen and bathroom cabinets or out of reach). LPA observed hand sanitizer in the back of the kitchen counter semi-inaccessible. LPA issued a technical advisory violation and informed Licensee to make it more inaccessible for children. LPA informed Licensee that poisons must be locked. Per Licensee there are no firearms, weapons or bodies of water and LPA did not observe any on the premises. The License, Parents Rights Poster, and Earthquake Preparedness was posted. The children's roster and Disaster drill is current (last date of drill July 31, 2023. The valve on the required 2A 10BC fire extinguisher indicates fully charged with a service date due in June 6, 2024. Smoke and carbon monoxide detectors in the dining room were tested and are in operable condition.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

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: DOUGLASS, MARIA & JOHN FAMILY DAY CARE	FACILITY NUMBER: 198002164
	VISIT DATE: 08/25/2023

NARRATIVE

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Both Licensees have current EMS approved Pediatric First Aid and CPR, (expires on May 2024). LPA observed the Licensees also have current Mandated Reporter training expires May 23, 2024 The Licensees have documentation indicating immunization regarding measles, pertussis and tuberculosis on file. LPA reviewed six children's files to be in compliance. Files included the following documentation: Parent's Rights, Personal, Affidavit for Liability insurance (not needed due to insurance), Identification and Emergency, Consent for Emergency Treatment, Additional Children in Care, Immunization records and safe sleep forms for infants.

The following was discussed: 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. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

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 that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the child's condition. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA explained form is available on CCLD website. The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

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: DOUGLASS, MARIA & JOHN FAMILY DAY CARE	FACILITY NUMBER: 198002164
	VISIT DATE: 08/25/2023

NARRATIVE

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LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. . .

LPA provided Licensee with Safe Sleep Pin 20-24-CCP information, Ratio information, and Items not Permitted, information on hazardous items that must be inaccessible. LPA also informed Licensee that infants may only be restrained in high chairs for eating and possibly daycare activities (coloring or school activities etc) LPA explained these to ensure that she provides care and supervision adhering to the information provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee John and Maria Douglass..

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

LIC809 (FAS) - (06/04)

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