198008133-7-22-2022-54-CC-MAYA-CGKTBW-20220722143549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198008133
Report Date: 07/22/2022
Date Signed: 07/22/2022 02:36:03 PM

Document Has Been Signed on 07/22/2022 02:36 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:	BUCKLEY FAMILY CHILD CARE		FACILITY NUMBER:	198008133
ADMINISTRATOR:	BUCKLEY, TAMARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 716-9665
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY:	14	CENSUS: 10	DATE:	07/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Licensee, Tamara Buckley		TIME COMPLETED:	03:00 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 July 22, 2022 at 11:15 am Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Tamara Buckley. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 8:00 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, Licensee, Licensee's Assistant and 10 children were present. Per Licensee, she does not have a dual license at this address. All areas identified on the facility sketch were inspected. This facility is a single family home that consists of three (3) bedrooms, two (2) bathrooms, dining room, living room, family room, detached garage, and fenced backyard. Areas that are accessible to children include: the family room, 1 bathroom, and backyard (fenced). Per Licensee, the children utilize the backyard (fenced) for outdoor activity. Areas off-limits to children include: 3 bedrooms, 1 bathroom, dining room, living room, and detached garage. LPA observed a door in between the dining room and family room that is closed and locked with a latch, making the child care area and 1 bathroom (designated bathroom for children) inaccessible to the rest of the home. LPA also observed child safety knobs installed on the gates located in the backyard. Per Licensee, children are dropped off and picked up from the side of the house and enter the family room (day care area) through the sliding door. The Licensee was advised that off-limit areas must be made inaccessible during operating hours.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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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Document Has Been Signed on 07/22/2022 02:36 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: BUCKLEY FAMILY CHILD CARE	FACILITY NUMBER: 198008133
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/22/2022

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 as the Licensee did not have a current proof of completion for the required Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/12/2022
	Plan of Correction
1 2 3 4	Licensee will complete the required Mandated Reporter Training (AB 1207) and submit proof of completion to LPA via e-mail by August 12, 2022.

Type B

Section Cited

CCR

102416.1(a)(6)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c). 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 as the Licensee did not have on record documentation of completion of training on Preventative Health and Safety (EMSA-approved) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/12/2022
	Plan of Correction
1 2 3 4	Licensee will complete the required Preventative Health and Safety Training (EMSA-approved) and submit proof of completion to LPA via e-mail by August 12, 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: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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: BUCKLEY FAMILY CHILD CARE	FACILITY NUMBER: 198008133
	VISIT DATE: 07/22/2022

NARRATIVE

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The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), The Earthquake Preparedness (LIC 9148), Emergency Disaster Plan (LIC 610A), and a Disaster and Fire Drill log. The last Disaster and Fire Drill was conducted on July 6, 2022.

Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. LPA did not observe any wall heaters in the facility. The facility has central air and heating. The home has a fireplace located in the living room with a secure screen. Detergents, cleaning compounds and medicines were made inaccessible to children in care. 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 pets, firearms, weapons or bodies of water on the premises. LPA observed age appropriate toys and napping equipment for children. LPA observed electrical outlet covers installed in the child care area. LPA observed the required fire extinguisher (2A-10BC) that is fully charged and was purchased on August 28, 2021. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detector and carbon monoxide detector was tested and is operable. First Aid kits and emergency supplies are available and located near the children's bathroom.

Licensee stated that she provides breakfast, lunch, and snacks to children. Per Licensee, children do not bring food from home. Licensee was informed that if food is brought from the child's home it shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review of 10 children's files, Licensee's file, and 1 staff (S1) file. Based on the file reviews, the children's records were complete and contained all of the required documents per Title 22 regulations, including the Individual Infant Sleep Plan (LIC 9227) and documentation for the 15 minute physical checks for sleeping infants. Based on the file review, Licensee's Assistant's record was complete and contained all of the required documents per Title 22 regulations.

Licensee has a current Pediatric First Aid and CPR certification (expires 08/16/2022). Licensee did not have on record the required Preventative Health and Safety Training (EMSA-approved) and Mandated Reporter Training (AB 1207). Licensee has proof of immunization against measles and pertussis. Licensee has documentation of declination for influenza on record. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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: BUCKLEY FAMILY CHILD CARE	FACILITY NUMBER: 198008133
	VISIT DATE: 07/22/2022

NARRATIVE

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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.

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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: BUCKLEY FAMILY CHILD CARE	FACILITY NUMBER: 198008133
	VISIT DATE: 07/22/2022

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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/inspection-process.

Deficiencies were cited per Title 22 regulations (refer to deficiency page).

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

Exit interview conducted and report was reviewed with Licensee, Tamara Buckley.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

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