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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003208
Report Date: 06/17/2019
Date Signed: 06/17/2019 05:04:21 PM

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:GREEN FAMILY CHILD CAREFACILITY NUMBER:
198003208
ADMINISTRATOR:GREEN, LA DORISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 608-2833
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 8DATE:
06/17/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:La Doris Green, LicenseeTIME COMPLETED:
05:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Susann Sanchez and Licensing Program Manager (LPM) Claudia Guangorena conducted an unannounced Required inspection to the above facility. Licensing staff met with La Doris Green, Licensee who guided analyst on a tour of the facility. Also present during this inspection was Licensee’s Assistant, Cherline Norwood. The licensee states that she currently has 8 children enrolled. During this inspection there were 8 children in care, three of them were infants. A current children’s roster is available and is current.

This is a one-story home which consists of 4 bedrooms, 1 bathroom, kitchen, living room, garage, front yard and backyard (fenced). The children use the bathroom in the hallway, living room, and backyard. Per licensee, areas off limits to children and parents include: all the bedrooms, garage, and front yard. The licensee provides food for children in care.

The licensee states that 1 adult and 0 children currently live in the home. Licensee states that she currently has six assistants. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, telephone service, ventilation and heating (central). The following was observed and reviewed during this inspection.

PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. Licensee's state that all poisons and clean compounds are kept in a locked bedroom.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019
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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 198003208
VISIT DATE: 06/17/2019
NARRATIVE
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Fireplaces and open face heaters are inaccessible to prevent access by children. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/03/19, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke detector was tested and is operable. This home is missing a carbon monoxide detector. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 04/02/19.

There is heating and ventilation for safety and comfort. There are toys available for children. The licensee states that there is a cell phone that is used and stays at the facility during operating hours.

The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. Per Licensee, children are not playing outdoors due to weather. The licensee states that supervision is provided at all times.

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 10/14/2019. There are first aid supplies available. Children’s records were reviewed.

H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
The following items were also discussed with licensee during this inspection.
PETS: There are no pets on the premises.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted.
PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019
LIC809 (FAS) - (06/04)
Page: 2 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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 198003208
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/01/2019
Section Cited
HSC
1597.543
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Carbon monoxide detectors required; inspection
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence
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Per Licensee, will submit a photo to LPA via email by POC date of 07/01/2019.
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 of these detectors during inspections. This requirement was not met as evidenced during inspection. Licensee did not have a cardon monoxide dectector. This poses a potential risk to the health and safety of children in care.
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Type B
07/08/2019
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home
The home shall be free from defects or conditions which might endanger a child. This requirement was not met as evidenced during inspection when LPA was touring the backyard. The backyard had items stacked on top one another.
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Per Licensee, will submit a photo to LPA via email by POC date of 07/08/2019.
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This poses a potential risk to the health and safety of children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019
LIC809 (FAS) - (06/04)
Page: 4 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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 198003208
VISIT DATE: 06/17/2019
NARRATIVE
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Infant Care: Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. The licensee stated the following as a supervision plan for infants: Licensee states that infants sleep in the living room. LPA provided the licensee with a copy of the Child Care Pro. LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. vider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. 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 how to access forms, regulations and quarterly updates on line at: www.ccld.ca.govAB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

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). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.



Based on the LPA’s observations and records review, 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.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
Exit interview was conducted with licensee. Appeal Rights were given and explained.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019
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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 198003208
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/01/2019
Section Cited
CCR
102421(a)
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Child's Records
The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement was not met as evidenced by LPA during children's file review. Child #4 and child #5 are missing forms.

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Per License, will submit proof of completed files to LPA by POC date of 07/01/2019.
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This poses a potential risk to the health and safety of children in care.
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Per License, will submit proof of completed files to LPA by POC date of 07/01/2019.
Type B
07/01/2019
Section Cited
CCR
102421(g)
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Child's Records
The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7). This requirement was not met as evidenced by LPA during children's file review. Child #4 and child #5 are missing forms.
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This poses a potential risk to the health and safety of children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019
LIC809 (FAS) - (06/04)
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