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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006610
Report Date: 06/07/2023
Date Signed: 06/07/2023 02:53:47 PM


Document Has Been Signed on 06/07/2023 02:53 PM - It Cannot Be Edited

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: 7DATE:
06/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Patricia Butler, LicenseeTIME COMPLETED:
03:15 PM
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On 06/07/23, 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 ten children enrolled based on the roster. There was 4 children and 3 infants with the Licensee and Licensee assistant. Licensee has a dual license #191593007. Hours of operation: Monday to Friday 6am to 6pm. Licensee states that sometimes hours are extended based on parents needs.

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), one bedroom 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: living room, (1) downstairs bedroom, all upstairs, 2 bathrooms, backyard (with pool). LPA observed safety gates installed to make the off-limit upstairs area/rooms inaccessible to children.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed age appropriate toys and other equipment inside the home and yards. LPA advised Licensee to always ensure careful supervision for all outdoor play equipment. There is a working phone maintained in the home. LPA observed detergents, cleaning compounds, medications, and other items which can pose a danger to children to be inaccessible areas or out of children's reach once LPA asked Licensee to removed items from under the kitchen sink. Technical Violation was given. LPA informed Licensee that poisons must be locked with a key or combination lock.

Per Licensee there are no firearms or weapons in the facility. The License, Parents Rights Poster, and Earthquake Preparedness was posted in the garage. The roster is current and the last disaster drill was conducted on 06/07/23 during inspection.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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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Document Has Been Signed on 06/07/2023 02:53 PM - It Cannot Be Edited

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: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. During tour LPA observed that Licensee has 2 fire extinguishers, 1 located in the kitchen without a service tag and the 2nd one in the garage and was expired. Per Licensee, has the receipt that she did purchase a new extinguisher but could not find it during inspection. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2023
Plan of Correction
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Per Licensee will get fire extinguisher serviced and submit proof to LPA via email by POC due date of 06/21/23.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) 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 is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. Licensee and Licensee assistant have a current CPR & First Aid, however CPR & First Aid are not ESMA approved and training was taken online. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2023
Plan of Correction
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Per Licensee will get take a ESMA approved in person CPR & 1st Aid class and submit proof to LPA via email by POC due date of 07/7/23.
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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
VISIT DATE: 06/07/2023
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LPA observed that the Licensee and Licensee assistant have documentation indicating immunization regarding measles, pertussis and tuberculosis on file. At 1:15pm during staff file review, Licensee and Licensee assistant have a current CPR & First Aid, however CPR & First Aid are not ESMA approved and training was taken online. Type B was given. There are first aid supplies available. At 12:25pm, LPA observed that Licensee has 2 fire extinguishers, 1 located in the kitchen without a service tag and the 2nd one in the garage and was expired. Type B was cited.

Children’s records were reviewed, including emergency information and were observed to be complete.Staff records were reviewed for approved, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate and expires on 05/16/24.

Licensee states that she is currently caring for infants and there are 3 infants enrolled. Licensee states that the infants will sleep in the nap room and the younger infant sleeps in the family room, where they are constantly supervised. Appropriate sleeping arrangements and cots were observed. Licensee was advised cribs or play yards cannot hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside, so it cannot be dislodged. Cribs and play yards must be free of loose articles and objects. No objects can be hung above or attached to the side of the crib. LPA advised the Licensee that infants cannot be swaddled, shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. LPA reviewed and provided PIN 20-24, LIC 9227 and a sample of a 15 minute sleep log. Licensee stated she was not aware of the new safe sleep regulations. Licensee was reminded that there is no smoking, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into that category are not permitted in the facility. The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats. LPA reminded Licensee that children can not sleep or eat in the garage.

Currently, children are using the front yard for outdoor play time. The outdoor play area was observed to be fenced. The licensee states that supervision is always provided when children are outside. The backyard is "off limits" and has a pool that is fence.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
VISIT DATE: 06/07/2023
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During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

LPA gave consult regarding the departments Technical Support Program (TSP) and left a brochure. There are no pets on the premises.

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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public- information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.


Based on the LPA's observations and records review the following deficiency will be cited today in accordance with California Title 22 Regulations. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, P. Butler.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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