198005290-6-17-2021-54-CC-KCHE-C43QDT-20210617120515

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198005290
Report Date: 06/17/2021
Date Signed: 06/17/2021 12:05:32 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:	WILSON FAMILY CHILD CARE		FACILITY NUMBER:	198005290
ADMINISTRATOR:	WILSON, BETTYE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 971-3011
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY:	14	CENSUS: 1	DATE:	06/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Licensee, Bettye Wilson		TIME COMPLETED:	12:15 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	Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 06/17/2021 at 11:00 AM. LPA Chicote conducted a screening call prior to entering the home. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Bettye Wilson who guided the LPA on a tour of the facility. There is one individual living in the home and all have criminal record clearance. At 11:05 AM, LPA observed a small dog and a cat in the home. There was one day care child present during today’s inspection. Licensee states that there are currently seven children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 24 hours, seven days a week. Licensee understands that she cannot provide care for children longer than 23 hours at a time. At 11:02 AM, LPA observed Bedroom 1 that Licensee states children will stay during overnight care to have bed and free of hazards. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on May 06, 2021. This is a single-story home which consists of two bedrooms and two bathrooms, kitchen, living room, den, patio and detached garage. Areas used by the children include the Bedroom 1 (used for overnight care and sleeping), Bathroom 1, and den. Per Licensee, areas off limits to children and parents include Bedroom 2 and detached garage. Per licensee, off limit areas are also locked during operating hours, at 11: 08 AM LPA observed doors to be locked. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. At 11:12 AM, LPA observed wall heater blocked by gate. Den, which is a separate house from main house, is main care area for children. There is a working telephone maintained in the home. LPA observed books stuffed animals, and other age appropriate Report continues- Page 1 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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 3

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: WILSON FAMILY CHILD CARE	FACILITY NUMBER: 198005290
	VISIT DATE: 06/17/2021

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

toys, free of loose and sharp parts. At 11:12 AM, LPA Chicote observed Bathroom 1, located in Den, to be free of hazards and handwashing posters posted. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock.

Per licensee, the children will have access to patio for outdoor play area. Patio area is located in between main house and den. LPA observed patio has adequate perimeter fencing through-out and wooden plank flooring. LPA observed plastic slide, bicycles, and other age appropriate toys free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises. Per licensee, they provide food for children in care.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors are in operable condition. At 11:11 AM, LPA observed First Aid kit in Bathroom 1 and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 02/19/2022
—Fire Extinguisher was last serviced on: 09/2020
—Mandated Reporter AB1207 Completed: 07/19/2019

The following were discussed:
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

Report continues- Page 2 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: WILSON FAMILY CHILD CARE	FACILITY NUMBER: 198005290
	VISIT DATE: 06/17/2021

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

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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are 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.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep, Lead Handout, and PIN 20-02-CCP “Coronavirus Information Guideline” was provided.

LPA reviewed and issued the 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.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 06/17/2021.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

At 12:15 PM, exit interview was conducted with Licensee, Bettye Wilson, a copy of this report was given and appeal rights were issued and discussed.
Report ends- Page 3 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3