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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008245
Report Date: 10/09/2019
Date Signed: 10/09/2019 05:09:30 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:ADAMS FAMILY CHILD CAREFACILITY NUMBER:
198008245
ADMINISTRATOR:ADAMS, SHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 904-5977
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 5DATE:
10/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Sheryl AdamsTIME COMPLETED:
05:20 PM
NARRATIVE
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ANNUAL RANDOM INSPECTION CONDUCTED IN ENGLISH
An Annual Random/Required Inspection was conducted by Licensing Program Analyst (LPA) Alicia Bailey and Licensing Program Manager (LPM) Claudia Guangorena. Licensing staff met with licensee, Sheryl Adams who guided licensing staff on a tour of the facility. This is a two story home. Residing in facility are 2 adults and 6 children. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Present in the facility on this date are: 5 infants 5 adults Day Care days and hours are: Monday thru Friday 9am-6pm. Licensee is dually licened through the county of Los Angeles. Foster Child Care Services thru Eggleston Services # 197805862

Areas used by the children were inspected as follows: Kitchen, living room, dining room, 1 bathroom and front yard.

Areas off limits include: All Bedrooms, the upstairs 2nd floor part of the house which includes 3 bedrooms and 1 bathroom. The Master Bedroom is located downstairs, the family room and back yard.
**Rooms that are off-limits need to be made inaccessible during operating hours** The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

There are NO weapons, firearms, *swimming pool or spa on the premises. The front yard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors, carbon monoxide and fire extinguisher (2A10BC) are in operable condition. Pediatric CPR/First Aid Exp 11/05/2020. (Need Verification that training is EMSA approved) Licensee's assistant is not current with her CPR/First Aid.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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 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: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 198008245
VISIT DATE: 10/09/2019
NARRATIVE
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Child Care Roster, Disaster Plan, Emergency Disaster Drill and Children's Records were reviewed.

Children records and required licensing forms were given & discussed as well as mandated child abuse reporting and criminal record clearance requirement.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/ Licensee has not taken the required training.

Health & Safety Code 1597.622(a1) Employees or volunteers at family day care home; immunization requirements; records; exemptions Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
Licensee's immunization's are not current. Licensee's assistant immunizations are not current.

The following was discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to licensure. Individuals within one month of their 18th birthday must be fingerprinted immediately. The existing, immediate $100 per individual Civil Penalty has been increased to 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. 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. LPA Bailey and LPM Guangorena observed there was no fingerprint clearance for Dezhamae Adams and Dominique Adams. Licensee Adams stated that Dominique Adams was there to pick up her child from day-care.

No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake – fire, disaster drills and safety, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby flyers given and discussed, Incidental Medical Services (IMS) was discussed.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 198008245
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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PERSONNEL REQUIREMENTS
The Licensee 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 by Licensee assistant does not have CPR/1st Aid training. This is a potential risk to the health and safety of children in care.
Type B
10/25/2019
Section Cited

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Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 102370.1(p), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility.The requirement is not met as evidenced by Licensee assistant does not have criminal record clearance with the facility.This is 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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2019
LIC809 (FAS) - (06/04)
Page: 5 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: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 198008245
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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Child Records
Licensee shall maintain in each child's file all the required and completred forms with signature and dates from the department. This requirement is not met as evidenced by: file review of several children files not being complete. This is a potential risk to the health and safety of children in care.
Type B
10/25/2019
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemptions Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an
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influenza vaccination between August 1 and December 1 of each year.
The requirement is not met as evidenced by Licensee assistant does not have any proof of the required vaccination. This is a potential risk to the health and safety of children in care.
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Type B
10/25/2019
Section Cited

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Mandated Child Abuse Reporting
Provide training including statewide guidance on the responsibilities of a mandated reporter for Licensee and employees of a licensed child day care facility. Licensee & staff have not taken the mandated reporting training.The requirement is not met as evidenced by Licensee and assistant does not have mandated reporter training. This is a potential risk to the health and safety of children in care.
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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2019
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: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 198008245
VISIT DATE: 10/09/2019
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Licensee has been advised of the following:
  • Dog(s) and or pets should be isolated from children in care.
  • 100% Outdoor supervision is required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors
  • Discuss Firearms in the home

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.

Child Day Care Facilities
Integrated Pest Management (IPM) http://apps.cdpr.ca.gov/schoolipm/childcare/main.cfm

****Licensee advised that signing the report does not imply agreement with the findings but is acknowledging receipt of the licensing report.****

Licensing staff observed a one small mouse in the off limits family room(patio area). Licensing staff inform the Licensee. Licensee stated she will contact her exterminator regarding the matter.

Exit interview was conducted with Licensee, including, but not limited to Provider Rights, Appeal Procedures

The following deficiencies are cited in accordance with Title 22 of California Code of Regulations and discussed with licensee: Sheryl Adams See 809 D attached.

Upon receipt, Licensee shall post the Notice of Site Visit (LIC 9213) and the citation page of the licensing report. The 9099D page and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in the issuance of a citation and the assessment of a $100 civil penalty per day.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 198008245
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
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:Vermin (mouse)

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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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6