198006328-1-21-2020-54-CC-DGIS-BL2UKF-20200121143904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198006328
Report Date: 01/21/2020
Date Signed: 01/21/2020 02:39:21 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:	JOHNSON FAMILY CHILD CARE		FACILITY NUMBER:	198006328
ADMINISTRATOR:	JOHNSON, KENDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 232-4725
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90037
CAPACITY:	12	CENSUS: 1	DATE:	01/21/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Kendra Johnson, Licensee		TIME COMPLETED:	02:45 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) Denise Gibbs conducted an unannounced annual random inspection to the above facility on 1/21/20 at 12:30 PM. LPA met with Kendra Johnson, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was C1, Licensee’s nephew (11 years old). Per Licensee, there is 1 child currently enrolled since Jan 2020. A current children’s roster was available for review. There was 1 child present upon arrival (nephew, not part of daycare). This is a two-story duplex (two separate addresses). Facility is located on the 2nd floor. Bottom address is 633 W 41st pl. Home consists of 3 bedrooms, 2 bathrooms, kitchen, living room, front yard and backyard (fenced). Main care is provided in the living room and 1 bedroom. The children use the bathroom in adjacent to the living room at the front of the house. LPA observed that there is a wall heater in the hallway and it is screened. Per Licensee, areas off limits to children and parents include: 2 bedrooms and 1 bathroom. The licensee provides food for children in care. Hours of operation are Mon-Fri 6am-6pm, and occasional weekends. The licensee states that 1 adult currently lives in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms or weapons 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. There is telephone service via a cellphone that is used and the stays at the facility during operation hours. There is ventilation and heating (ceiling fans). The following was observed and reviewed during this inspection: LPA observed exposed outlets in the living room and main care bedroom. LPA observed off limit rooms and ------------------Page 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 198006328
	VISIT DATE: 01/21/2020

NARRATIVE

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bathroom do not have locks or barrier to keep rooms off limits. The licensee states that there are no poisons in the home 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 clean and free of hazards.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. LPA did not observe toys or material for children in care. Per licensee, she just began caring for children this month and has toys in storage. School-age child in care does not nap. Licensee is not currently caring for infants.

Children occasionally use the front yard and back yard for outdoor play. Both outdoor play areas were observed to be fenced. LPA did not observe any objects that can pose a danger to children on the outdoor yard. There are no pools or spas, or other bodies of water. Licensee has a dog that stays downstairs during operating hours.

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 6/2020. There are first aid supplies available.

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

The licensee does not have proof of immunization against influenza, pertussis, and measles. LPA observed that the Licensee does not 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. LPA observed that licensee has not had children in 3 years and current child was just enrolled Jan 2020. -------------Page 2

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 198006328
	VISIT DATE: 01/21/2020

NARRATIVE

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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.
Smoking is prohibited in a licensed Family Child Care Home. LPA did not observe anyone smoking in the home.

LPA discussed and provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS, updated Parent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large), Lead and Never Shake a Baby pamphlet.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

Incidental Medical Services (IMS):
The licensee states that she will/will not 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 to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.
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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 198006328
	VISIT DATE: 01/21/2020

NARRATIVE

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Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (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 Kendra Johnson, Licensee, including, but not limited to Appeal Procedures and Appeal Rights.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 198006328
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/21/2020 Section Cited	1 2 3 4 5 6 7	1596.7995 Employees...at day care center...Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on record review licensee did not maintain proof of immunization for S1. This poses a potential Health, Safety or Personal Rights risk to children in care.	8 9 10 11 12 13 14
Type B 02/21/2020 Section Cited	1 2 3 4 5 6 7	1596.8662(3) Availability of information regarding detecting and reporting child abuse and neglect...employee...shall complete the...training...renewal ...every two years... This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation and record review Director did not maintain proof of mandated reporter training for S1. This poses a potential Health, Safety or Personal Rights risk to children in care.	8 9 10 11 12 13 14

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 Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 198006328
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/21/2020 Section Cited	1 2 3 4 5 6 7	102417(d) Operation of a Family Child Care Home (d)The home shall provide safe toys, play equipment and materials. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observation and interview licensee did not have toys and material for children in care. This poses a potential Health, Safety or Personal Rights risk to children in care.	8 9 10 11 12 13 14
Type B 02/03/2020 Section Cited	1 2 3 4 5 6 7	102417(g) 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 by:
	8 9 10 11 12 13 14	Based on observation and interview licensee did not maintain covered electrical outlets and locks or barriers for inaccessible rooms. This poses a potential Health, Safety or Personal Rights risk to children in care.	8 9 10 11 12 13 14

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 Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

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