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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006584
Report Date: 06/26/2019
Date Signed: 06/26/2019 05:08:01 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:NICKLES-WEEMES FAMILY DAY CAREFACILITY NUMBER:
198006584
ADMINISTRATOR:NICKLES,SHEYRLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 808-9213
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 14DATE:
06/26/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:14 PM
MET WITH:Sheyrl Nickles-WeemesTIME COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Susann Sanchez and Warren Birks conducted an unannounced case management inspection. LPAs met with licensee Sheyrl Nickles-Weemes, Licensee whom was present alone with 14 children. Licensee's assistant arrived approximately one hour later. LPAs informed Licensee that when she is alone without an assistant she can only care for eight children and is out of ratio. Licensee indicated that her assistant went on a break.

LPAs also discovered that the Licensee did not report an unusual incident (that occurred on 6/13/2019) to Licensing within 24 hours. No external report were given to Licensee regarding the incident. Licensee indicated she will send in a written report regarding the incident.

The Notice of Site Visit (LIC 9213) and Licensing Report– 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 $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt. Appeal Rights were explained. Exit interview conducted with Licensee.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
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: NICKLES-WEEMES FAMILY DAY CARE
FACILITY NUMBER: 198006584
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2019
Section Cited
CCR
102416.5(d)(e)
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Staffing Ratio and Capacity:
If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidenced by: LPAs observed Licensee alone with 14
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Licensee indicated that her assistant was on break and she will make sure that Licensee other assistant will be present at all times. Licensee will email LPA a plan with staff names and hours.
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children. This poses an immediate risk to 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: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 2 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: NICKLES-WEEMES FAMILY DAY CARE
FACILITY NUMBER: 198006584
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2019
Section Cited
CCR
102416.2
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Reporting Requirements: The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). A report shall be made to the Department…following the occurrence during the operation of a family day care
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Licensee indicated she didn't know she had to report the incident to the department and will submit an Unusual incident Report to the Licensing Department.
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(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child."

Licensee was questioned by Law enforcement and did not report the incident to Licensing within 24 hours.
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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: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
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