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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008245
Report Date: 08/03/2023
Date Signed: 08/03/2023 02:33:51 PM


Document Has Been Signed on 08/03/2023 02:33 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:ADAMS FAMILY CHILD CAREFACILITY NUMBER:
198008245
ADMINISTRATOR:ADAMS, SHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 904-5977
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 0DATE:
08/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Sheryl Adams, LicenseeTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced required one year inspection to the above facility on 08/03/2023. LPA arrived at the facility at 12:25PM. Licensee is currently closed but does not want to go inactive. Per Licensee, due to personal family matters, facility is open and closed on a day to day basis. Per Licensee, only children enrolled are family members. Licensee will continue to call the Regional Office when she is closed. Currently hours of operation vary. At 12:40pm, Licensee then guided analyst on a tour of the facility. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. LPA did not observe any children.

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 which includes 3 bedrooms and 1 bathroom. The Master Bedroom is located downstairs, the family room and back yard.

Individuals who reside in the home were noted and discussed. Per Licensee, they currently do not have an assistant.
Licensee was reminded that all adults 18 and over, including employees and volunteers, expect as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be up assessed if this regulation is violated.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a land line and a cellphone that are used. There is ventilation and heating (central). Safe toys play equipment and materials were observed. Licensee states that there are no firearms stored in the home. Smoke and carbon monoxide detectors were tested to ensure that they are operable.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 198008245
VISIT DATE: 08/03/2023
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Consult was given regarding: inactive status, changing capacity to a Small FCCH, hours of operation and fingerprint clearances.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. Per Licensee, there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 06/25/23 as indicted on the receipt has. The licensee has completed training on Pediatric First Aid and CPR and expires 05/20/25. Licensee's Mandated Reporter training expires 06/10/2025. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children. The licensee does have proof of immunization against influenza, pertussis, and measles. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.

Licensee states that they are not currently caring for infants. LPA advised the Licensee that if they do care for infants in the future, infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. a copy of the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect. 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.

Currently, children play at Stevenson Park which is located right behind the Licensee home. The licensee states that supervision is always provided.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
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: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 198008245
VISIT DATE: 08/03/2023
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Children’s records were reviewed, including emergency information and were observed to be complete.
Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Consult was given regarding physical office file. Updates need to be made LIC 279- application & LIC 279B - current children living in the home.

There are 2 dogs in the house. A small dog and a big dog. Licensee showed LPA proof of vaccines for both dogs.

Licensee took Water Safety class and it expires 05/20/25.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm.



Licensee was informed of the MyChildCare.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resources and Referral Agencies (R&Rs) throughout California.

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 CARE 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/process.

During the exit interview Licensee P.Davis, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, S. Adams

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
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