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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006610
Report Date: 10/15/2024
Date Signed: 10/15/2024 03:45:51 PM

Document Has Been Signed on 10/15/2024 03:45 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BUTLER FAMILY DAY CAREFACILITY NUMBER:
198006610
ADMINISTRATOR/
DIRECTOR:		BUTLER, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 223-3132
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
10/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:BUTLER, PATRICIA / LICENSEETIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced random/annual inspection to the above facility. LPA met with Patricia Butler / Licensee, and discussed the purpose of today's visit.

Per Licensee, facility is closed today for facility maintenance, no children present. LPA gave Licensee Entrance Checklist and Licensee allowed LPA to conduct a self guided tour of the facility. Per Licensee stated Foster Licensee is pending.

Hours of Operation: Monday to Friday 6am to 6pm. Licensee states that sometimes hours extended based on parents needs or if weekends are needed. Licensee cares for children ages infants - 17 years old.

This is a two story home which consists of 6 bedrooms, 3 bathrooms, kitchen, living room, 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 has safety gates installed to make the off-limit upstairs area/rooms inaccessible to children.

Cleaning components and poisons remain locked in locked storage cabinet located in the garage. Sharps are placed in inaccessible area in laundry room, locked.

Fire place was observed in family room secured/barricaded. Disaster and Fire Drill was conducted on 10/1/24. Fire extinguisher needs to get serviced 6/16/23 was the last inspection date, consultation was given. Smoke and Carbon monoxide detector tested and operable. (Page 1/ Cont...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
VISIT DATE: 10/15/2024
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Outdoor area is an off limit area, there is a pool in the backyard, with a locked and secured fence around the pool, children are not allowed in the backyard. Garage is used as the day care area. Children use bathroom in the hallway. Per Licensee, has liability insurance, LPA reviewed liability insurance and licensee has appropriate liability bond amount. Per licensee, there are no guns and no pets on premises.

Children and staff records were reviewed. Licensee file was reviewed Mandated Reporter certificate expires 11/28/25 and Pediatric First Aid and CPR expires 6/29/25. LPA reviewed documentation required when having assistant staff present. LPA conducted staff interview. Children’s records were reviewed, total of (2) files reviewed, files had appropriate documentation. LPA reviewed roster, roster is current.

During today's visit Licensee updated Application LIC279 (hours of operation) and updated LIC279B Current Children living in the home. No children are living in the home.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 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. (Pg. 2...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BUTLER FAMILY DAY CARE
FACILITY NUMBER: 198006610
VISIT DATE: 10/15/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Based on today’s visit, Per Regulations Title 22, the facility was found in compliance, and no citations were given today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee Angela Ennis. (Page 3 / Cont...)

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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