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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007112
Report Date: 05/13/2019
Date Signed: 05/15/2019 11:21:43 AM

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:TERRY FAMILY CHILD CAREFACILITY NUMBER:
198007112
ADMINISTRATOR:TERRY, JUDY DARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 431-7471
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:14CENSUS: 6DATE:
05/13/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Judy TerryTIME COMPLETED:
04:00 PM
NARRATIVE
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A Case Management inspection was conducted by Licensing Program Analyst (LPA), Timothy Fields. LPA met with Licensee, Judy Terry. Upon arrival LPA observed an infant in a baby bouncer places on a counter top. The infant was asleep with blanket covering its body. Licensee was informed baby bouncers are not permitted in the child care home and the counter top was not an appropriate surface to place an infant strapped in a baby bouncer. There was a second sleeping child in a bouncer in the living room. When inspecting the backyard, LPA observed dog feces in the grass accessible to children in care.

The following deficiencies are cited in accordance with Title 22 of California Code of Regulations and discussed with licensee:
  1. Personal right
  2. Operations of a Family Child Care home.

See 809 D attached.
The licensee shall require each recipient (Parent/guardian) of a licensing report documenting a
Type A citation resulting from a compliant investigation and any licensing document pertaining to a conference, and any summary of an accusation indicating the Department’s intent to revoke a license, to sign LIC 9224 form, indicating that he or she has received the documents and the date they were received. The licensee shall keep verification of receipt in each child’s file.

Exit interview conducted with licensee. Appeal Rights provided and explained. Notice of Site Visit must be posted for (30) days. Failure to do so may result in a $100.00 civil penalty.

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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: TERRY FAMILY CHILD CARE
FACILITY NUMBER: 198007112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2019
Section Cited
CCR
102423(a)(2)
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Personal Rights:

To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

The requirement is not met as evidenced by LPA observing a sleeping infant in a
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Licensee states a written declaration will be submitted by POC date 5/17/19 stating children will not be places in baby boucers as well as not being places on counter tops.
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baby bouncer places on a counter top. This poses an immediate risk to the health and safety of 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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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: TERRY FAMILY CHILD CARE
FACILITY NUMBER: 198007112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2019
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home

The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:

The requirement is not met as evidenced by
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Licensee removed dog feces during the visit.
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LPA observing dog feces in the backyard accessible to children.
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3