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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007112
Report Date: 01/07/2020
Date Signed: 01/07/2020 02:22:10 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: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: 5DATE:
01/07/2020
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Judy TerryTIME COMPLETED:
02:35 PM
NARRATIVE
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ANNUAL/REQUIRED INSPECTION CONDUCTED IN ENGLISH

An Annual Required inspection was conducted by Licensing Program Analyst (LPA), Timothy Fields and Nolan Tcheng. LPA was guided on a tour of the facility by adult Devin Zorika. This is a single story home with three bedrooms and two bathrooms. Residing in the home are two adults and no children. Upon arrival three children were present.

One infant child was observed in a Graco pack and play located in the living room. The remaining two infants were sleeping in pack and plays in the accessible bedroom. Licensee Judy Terry arrived after the tour of the home had concluded with two additional children. LPAs observed a baby bouncer on top of the kitchen counter. There was no baby inside the bouncer at the time of inspection.

Care is provided in the living room. The first bedroom located in the hallway is used for napping and the adjacent guest bathroom is also accessible to children in care. The remaining two bedrooms plus bath located at the end of the hallway is off limits and made inaccessible with a child proof gate. The kitchen is accessible but made off limits with a child proof gate when not in use. There was no fire place observed in the home. Licensee has an wall heater inaccessible from children in care. Licensee has one dog. The front yard is off limits while the backyard is used for outdoor activity space. There were no detached sheds observed. Child have no access to the garage.

All rooms that are off-limits need to be made inaccessible during operating hours. Storage areas for poisons, detergents, cleaning compounds, medicines, and other items which pose a danger to children were observed to be inaccessible to children in care. LPA observed the home to be kept clean and orderly, with heating and ventilation for safety and comfort. Capacity and ratio was observed to be in compliance. Licensee complied with inspection authority.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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: TERRY FAMILY CHILD CARE
FACILITY NUMBER: 198007112
VISIT DATE: 01/07/2020
NARRATIVE
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Per licensee there are no weapons or firearms in the home. Telephone service was in operable condition. There are no *swimming pool or spa on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors, carbon monoxide detector, and fire extinguisher (2A 10BC) are in operable condition.

-Pediatric CPR and First Aid expires: 1/29/20
-Child Care Roster, Disaster Plan, and Children's Records were discussed.
-Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement. Licensee does not carry liability insurance for the day care.

The following was discussed: Individuals who are 18 years of age or older living or working in the home must be finger print cleared prior to licensure or living/working in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. An immediate $100 per day Civil Penalty for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations per individual will be issued. If an individual has a clearance with the Department, a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used.

During operating hours no smoking, no infant walkers, Johnny jumpers, Exersaucers and any other item that falls into that category are allowed in the facility. Earthquake, fire disaster, and safety drill posting requirement were explained in detail on this date.

Licensee has been advised of the following:
· Dog(s) and or pets should be isolated from children in care.
· It is recommended that a First Aid kit be available on premises.
· Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
LIC809 (FAS) - (06/04)
Page: 6 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: TERRY FAMILY CHILD CARE
FACILITY NUMBER: 198007112
VISIT DATE: 01/07/2020
NARRATIVE
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The following deficiencies are cited in accordance with Title 22 of California Code of Regulations and discussed with licensee:
  1. Children were left in the care of Devin Zorika who does not have a criminal record clearance. A $100 civil penalty will be assessed during todays inspection.
  2. Devin Zorika does not have a Pediatric CPR/First aid certification.
  3. LPA observed a baby bouncer and saucer chair in the accessible bedroom and on top of the kitchen counter.
  4. Licensee has not completed the mandated reporter training. www.mandatedreporterca.com

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.

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. Required measles, pertussis, and influenza vaccinations were discussed.

Online copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Safe sleep practices was discussed.

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: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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: TERRY FAMILY CHILD CARE
FACILITY NUMBER: 198007112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2020
Section Cited

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Criminal Record Clearance:
Obtain a California clearance or a criminal record exemption as required by the Department.
The requirement is not met as evidenced by children left in the care of Devin Zorika who does not have a criminal record clearance.
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This poses an immediate risk to the health and safety of children in care. A $100 civil penalty will be assessed during todays inspection.
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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: 01/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2020
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: TERRY FAMILY CHILD CARE
FACILITY NUMBER: 198007112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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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.

The requirement is not met as evidenced
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by Devin Zorika not having a Pediatric CPR/First aid certification. This poses a potential risk to the health and safety of children in care.
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Type B
01/08/2020
Section Cited

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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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LPA observing a baby bouncer and saucer chair in the accessible bedroom and on top of the kitchen counter. This poses a potential 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: 01/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2020
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: TERRY FAMILY CHILD CARE
FACILITY NUMBER: 198007112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/14/2020
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
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The requirement is not met as evidenced by licensee stating she has not completed the mandated reporter training. This poses a potential 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: 01/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2020
LIC809 (FAS) - (06/04)
Page: 5 of 6