198007011-10-28-2022-54-CC-MAYA-CKMR9X-20221028125018

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198007011
Report Date: 10/28/2022
Date Signed: 10/28/2022 12:50:38 PM

Document Has Been Signed on 10/28/2022 12:50 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:	HAWKINS FAMILY CHILD CARE		FACILITY NUMBER:	198007011
ADMINISTRATOR:	LUCINDA HAWKINS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 867-7927
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY:	14	CENSUS: 11	DATE:	10/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee, Lucinda Hawkins		TIME COMPLETED:	01:00 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	On October 28, 2022 at 9:00 AM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Lucinda Hawkins. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 6:00 AM to 6:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, the Licensee, Licensee's Husband, and Licensee's Adult Son were providing care to eleven (11) children in the gated driveway. All areas identified on the facility sketch were inspected. This facility is a two-story family home that consists of seven (7) bedrooms, four (4) bathrooms, family room, living room, kitchen, detached garage, gated drive way, and fenced backyard. Areas that are accessible to children include: two (2) bedrooms (located downstairs), 2 bathrooms (located downstairs), family room, living room, kitchen, gated driveway, and fenced backyard. Per Licensee, the children utilize the gated driveway and fenced backyard for outdoor activity. Areas off-limits to children include: five (5) bedrooms (1 located downstairs and 4 located upstairs), 2 bathrooms (located upstairs), and garage. At 9:25 am, LPA did not observe a child safety gate or barrier installed, making the stairs and upstairs inaccessible to children. LPA also observed the off-limit bedroom door located downstairs open, making the room accessible to children in care. During the inspection, Licensee installed a child safety gate to the stairs, and closed/locked the downstairs bedroom door. Licensee was advised that off-limit areas must be made inaccessible during operating hours or while children in care are present.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

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: HAWKINS FAMILY CHILD CARE	FACILITY NUMBER: 198007011
	VISIT DATE: 10/28/2022

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The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), Earthquake Preparedness (LIC 9148), and Emergency Disaster Plan (LIC 610A). Licensee has a current Facility Roster (LIC 9040). Licensee also has verification of disaster and fire drills. The last drill was conducted on September 1, 2022.

Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home does not have any wall heaters or fireplaces. The home has central air and heating. Detergents, cleaning compounds and medicines were made inaccessible to children. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock. Per Licensee, there are no bodies of water, firearms and/or weapons on the premises. Per Licensee, the home has 1 dog that is kept isolated from the children in care. LPA observed age appropriate toys and napping equipment for children. LPA also observed electrical outlet covers installed in the child care areas.

LPA observed the required fire extinguisher (2-A:10-B:C) that is fully charged and was purchased on October 28, 2022. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detectors and carbon monoxide detectors were tested and are operable. First Aid kit and emergency supplies are available and kept in a bedroom located downstairs. Licensee was reminded that food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review of 5 children's records, Licensee's record, and Licensee's Husband's record. Based on the record reviews, Licensee did not have verification of the 15 minute physical checks while children are napping available for review. Based on record reviews, the Licensee did not have a record available for review for her Adult Son, who assists with providing child care. Licensee's husband also assists with providing child care and did not have the following items available for review: current Pediatric First Aid and CPR certification, current Mandated Reporter Training certificate, Preventative Health and Safety Practices certificate of completion, and immunization record for measles or documentation of exemption.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

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: HAWKINS FAMILY CHILD CARE	FACILITY NUMBER: 198007011
	VISIT DATE: 10/28/2022

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Licensee has proof of immunization against pertussis, influenza, and a TB clearance. Licensee did not have the immunization record for measles or documentation of exemption available for review. Licensee did not have a current Pediatric First Aid and CPR certification (expired November 9, 2019). Licensee did not have the Preventative Health and Safety Practices certificate of completion available for review. Licensee did not have a current Mandated Reporter Training (AB 1207) available for review (expired February 9, 2022). Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.

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.

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

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

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: HAWKINS FAMILY CHILD CARE	FACILITY NUMBER: 198007011
	VISIT DATE: 10/28/2022

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platforms.

LPA provided assistance to the Licensee on how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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/inspection-process.

LPA requested that the Licensee submit an updated Facility Sketch (LIC 999) to LPA via e-mail by November 28, 2022. LPA advised the Licensee that the sketch of the floor plan must include the first floor, second floor, and outside yard. LPA also advised the Licensee that the Floor Sketch must label rooms, identify rooms that will be used by clients/children, include door and window exits from rooms, show room dimensions, and identify utility shut-off locations.

Deficiencies were cited during today's inspection (refer to deficiency pages).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Lucinda Hawkins.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/28/2022 12:50 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: HAWKINS FAMILY CHILD CARE	FACILITY NUMBER: 198007011
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 personnel records (Licensee, Licensee's Husband, and Licensee's Adult Son) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/28/2022
	Plan of Correction
1 2 3 4	Licensee and Licensee's Husband will renew the Mandated Reporter Training (AB1207) and the Licensee's Adult Son will complete or renew the same training, and the Licensee will submit proof completion to LPA via e-mail by 11/28/2022.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 personnel records (Licensee, Licensee's Husband, and Licensee's Adult Son) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/28/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of immunizations for Licensee (measles), Licensee's Husband (measles), and Licensee's Adult Son (measles, pertussis, influenza, and TB clearance) or documentation of exemption to LPA via e-mail by 11/28/2022.

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 Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/28/2022 12:50 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: HAWKINS FAMILY CHILD CARE	FACILITY NUMBER: 198007011
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 personnel records (Licensee, Licensee's Husband, and Licensee's Adult Son) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/28/2022
	Plan of Correction
1 2 3 4	Licensee, Licensee's Husband, and Licensee's Adult Son will complete the Preventative Health and Safety Practices (EMSA-approved), and the Licensee will submit proof of completion to LPA via e-mail by 11/28/2022. Licensee and Licensee's Husband will renew their Pediatric First Aid and CPR certification (EMSA-approved), and Licensee will submit proof of completion to LPA via e-mail by 11/28/2022.

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 personnel record (Licensee's Adult Son) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/28/2022
	Plan of Correction
1 2 3 4	Licensee will submit the following form for her Adult Son/Assistant to LPA via e-mail by 11/28/2022: Statement Acknowledging Requirement to Report Child Abuse (LIC 9108).

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 Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

LIC809 (FAS) - (06/04)

Page: 6 of 8

Document Has Been Signed on 10/28/2022 12:50 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: HAWKINS FAMILY CHILD CARE	FACILITY NUMBER: 198007011
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above in 2 children's records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/28/2022
	Plan of Correction
1 2 3 4	The Licensee will submit to LPA via e-mail documentation for the 15 minute physical checks for children (24 months and younger) napping (sleep log) for at least one week by 11/28/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

LIC809 (FAS) - (06/04)

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