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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007710
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:03:46 PM


Document Has Been Signed on 09/01/2022 02:03 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:LY FAMILY CHILD CAREFACILITY NUMBER:
198007710
ADMINISTRATOR:LY, FRANCESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 630-8310
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY:14CENSUS: 3DATE:
09/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:Frances LyTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Jennifer Hua conducted an unannounced Required - 1 Year on-site inspection. LPA was greeted by Licensee. A COVID-19 risk assessment was conducted. LPA stated the purpose of the visit and provided LIC 126 Entrance Checklist to facilitate the inspection. LPA was guided to a tour by Licensee. This is a two-story home with 4 bedrooms and 3 bathrooms. There are a total of 2 adults and 0 minor residing in the home. There were three children in care during the inspection. The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. Operating hours are Monday-Friday 8:30am - 6pm.

All child care areas identified on the Facility Sketch were inspected to include the following:
· Childcare areas: Living room, day care room (attached converted garage), hall bathroom and fenced backyard and kitchen, .
· Off limit areas: Entire upstairs. Safety gate at bottom of stairs, front yard, dining area, laundry room in day care room (licensee will install gate), downstair bedroom.

All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating (central). The licensees state that there are no poisons in the home. The licensees understand that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. The valve on the required 2A 10BC fire extinguisher indicates it was fully charged but has not been serviced annually. Licensee stated will purchase a new one today. Carbon monoxide detector in the kitchen was tested and was operable. Smoke detector in hallway not working properly, when tested, the sound is faint. licensee stated will install a new smoke detector today...

Backyard is adequately fenced and there is no bodies of water on the premise.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LY FAMILY CHILD CARE
FACILITY NUMBER: 198007710
VISIT DATE: 09/01/2022
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Per licensee, there are no weapon on the premise. There are no doge/pets. There are age appropriate toys, equipment were observed for children. Posting requirements were observed to be posted at the time of inspection.

Children Forms/Records to Keep in Your Family Child Care Home were reviewed.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

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 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 Per Licensee, IMS is not provided



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.

All adults present have obtained a criminal record clearance. The licensee has proof of current pediatric first aid and CPR (expires: 6/4/2024). Licensee has not completed the required mandated reporter training due to language barrier.. Roster is not updated, licensee stated update today. Per licensee, drills were conducted in May 2022 but did not document as required. Licensee documented on drill log during visit.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LY FAMILY CHILD CARE
FACILITY NUMBER: 198007710
VISIT DATE: 09/01/2022
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No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility. Licensee observed 2 saucer chairs in the living room, licensee stated will return to parents at pick up. Licensee put them in the backyard.

INFANT CARE: The infant will sleep in the day care where they are constantly supervised. Appropriate sleeping arrangements and cribs will be available/observed. (one crib for each infant in care is required). Cribs or play yard will not 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 shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the time of each 15-minute LIC 9227 Plan shall be completed for each infant up to 12 months of age. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.


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

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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/tion-process.

Deficiency cited on attached 809D.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee. Copy of report provided.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 09/01/2022 02:03 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: LY FAMILY CHILD CARE
FACILITY NUMBER: 198007710

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2022

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) the licensee did not comply with the section cited above in the fire extinguisher has not been serviced since 2017, but it is still fully charged. Smoke detector, when tested has a faint sound not a loud beep, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2022
Plan of Correction
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Per licensee, will purchase new fire extnguisher and install new smoke detector today and will submit corrections to LPA by 9/2/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4