<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006610
Report Date: 02/26/2020
Date Signed: 02/26/2020 03:48:16 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:BUTLER FAMILY DAY CAREFACILITY NUMBER:
198006610
ADMINISTRATOR:BUTLER, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 223-3132
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 3DATE:
02/26/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Patricia Butler, LicenseeTIME COMPLETED:
04:05 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) Susann Sanchez conducted an unannounced random inspection to the above facility. LPA met with Patricia Butler, Licensee who guided analyst on a tour of the facility. The licensee states that she currently has eight children enrolled. There was no roster available during inspection. Licensee has a dual license #191593007.

This is a two story home which consists of 6 bedrooms, 3 bathrooms, kitchen, living room (FIREPLACE inaccessible), family room, garage and backyard (fenced). The children use the family room, garage (No napping or feeding takes place in the garage), two bedrooms and kitchen and front yard.. There is a restroom in the hallway which the children use. Per licensee, areas off limits to children and parents include: all upstairs, 2 bathrooms, backyard (with pool).

The licensee states that 3 adults and 1 child currently live in the home. Licensee states that she currently has three assistant. 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. There is bodies of water on the premises (pool in the backyard).

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, 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. Poison is locked in a cabinet in the laundry room.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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 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: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
VISIT DATE: 02/26/2020
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
Fireplaces and open face heaters are inaccessible to prevent access by children. The valve on the required 2A 10BC fire extinguisher indicates fully charged however last date of service is unknown. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke detector was tested and operable. The FCCH had no carbon monoxide detectors. The licensee has no proof of current Pediatric First Aid and CPR. There are first aid supplies available. 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 02/26/2020.

There is heating and ventilation for safety and comfort. Where children are less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. There are toys available for children. The licensee states that there is a land line on and a cell phone 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 front yard for outdoor play time. The licensee states that supervision is provided at all times. LPA observed a pool in the backyardsee through portable mesh fencing that surrounds the pool. The "Licensee agreed to keep the fencing in place whenever licensed care is provided, and so long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff."

The licensee is observed to be operating within the license capacity limitations.
LPA was unable to review children’s records. Per Licensee, her daughter was helping her organize the files and do not remember where she placed them.

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 licensee does have proof of immunization against influenza, pertussis, and measles.

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.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
VISIT DATE: 02/26/2020
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
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 NOT PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME. DO NOT SLEEP CHILDREN IN CAR SEATS.

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 bedrooms. LPA 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. 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.

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.gov. AB1207 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.



SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2020
Section Cited

1
2
3
4
5
6
7
Operation of a Family Child Care Home
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not met as evidenced by: LPA during inspection. Licensee is not have a current roster. This poses a potential risk to the health and safety of children in care.
Type B
03/18/2020
Section Cited

1
2
3
4
5
6
7
Child's Records: The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419 (d). 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 inspection. Licensee is not have a
8
9
10
11
12
13
14
 children's files. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
03/18/2020
Section Cited

1
2
3
4
5
6
7
Fire extinguishers and smoke detectors shall meet State Fire Marshal standards.Fire extinguisher is in the green however last date of service is unknown.This requirement was not met as evidenced by: Fire extinguisher service date unknown. This is a potential risk to children in care.
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) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2020
LIC809 (FAS) - (06/04)
Page: 3 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: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2020
Section Cited

1
2
3
4
5
6
7
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 of these detectors during inspections. This requirement was not met as evidenced by
8
9
10
11
12
13
14
LPA during inspection. There was no carbon monoxide detector in the home. This poses a potential risk to the health and safety of children in care
.

8
9
10
11
12
13
14
Type B
03/27/2020
Section Cited

1
2
3
4
5
6
7
Personnel Requirements: The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.This requirement was not met as evidenced by LPA during inspection, Licensee was
8
9
10
11
12
13
14
unable to provide proof of current First Aid & CPR. This poses a potential risk to the health and safety of 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2020
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: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
VISIT DATE: 02/26/2020
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
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, Patricia Butler. Appeal Rights were given and explained.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
Page: 6 of 6