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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010065
Report Date: 11/26/2019
Date Signed: 11/26/2019 04:02:04 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:HOUSTON FAMILY CHILD CAREFACILITY NUMBER:
198010065
ADMINISTRATOR:HOUSTON, NIKITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 778-1624
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:14CENSUS: 3DATE:
11/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Nikita HoustonTIME COMPLETED:
04:15 PM
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An Annual Random/Required Inspection was conducted by Licensing Program Analyst (LPA) Alicia Bailey on this date. LPA Bailey met with licensee Houston, at 12:30pm and explained the nature of the inspection. The Licensee guided the analyst on a tour at 12:32pm of the facility on this date. This is a single story home, residing in facility are 2 Adults and 0 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. A parent board with required postings was observed at the entrance of the facility. Present in the facility on this date are: 1 adult 4 children (5 children enrolled License for large FCCH). Licensee child ratios were observed to be in compliance. Day Care days and hours are: Monday thru Sunday 6:00am to 5:00am 23 hours.

Areas used by the children were inspected as follows: living room, dining room, Kitchen, 1 bedrooms, 1 bathrooms, front yard and Back yard. Licensee states main care is provided in living room and dining room.

Areas off limits include: Master Bedroom
**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 observed on the premises. LPA Bailey toured the front yard and backyard, LPA Bailey observed that both areas is adequately fenced and was inspected for hazards .Outdoor equipment was inspected for safety, good repair and appropriateness.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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: HOUSTON FAMILY CHILD CARE
FACILITY NUMBER: 198010065
VISIT DATE: 11/26/2019
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At 12:20PM LPA Bailey observed the kitchen counter tops were clean and free of clutter or standing food. Kitchen Cabinets has safety lock and knives and medicine was in upper secure cabinet. Licensee provides breakfast, lunch and snack. At 12:36PM LPA Bailey observed there are age appropriate toys and napping equipment on the premises. LPA Bailey observed first aid kit, expire 4/2020, fire extinguisher 2A10BC in the kitchen .The smoke detectors, carbon monoxide was tested by LPA are in operable condition. Licensee PED F/A & CPR EXP. 02/08/20

At 1:30 PM LPA Bailey reviewed the Disaster Plan, Emergency Disaster Drill ( current drill perform on 10/23/19) were reviewed.

A current Children roster was viewed and maintained for a period of 3 years, even after children no longer are attending the facility.


Children records and required licensing forms were reviewed for completeness. Mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement was reviewed.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/
Licensee completed on: 01/25/2018
Licensee assistant completed on:10/13/2018

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 has all Immunization's
Licensee Assistant has all Immunization's

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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: HOUSTON FAMILY CHILD CARE
FACILITY NUMBER: 198010065
VISIT DATE: 11/26/2019
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Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.

The licensee is not providing Incidental Medial Services at this time.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - 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



LPA Bailey reviewed with Licensee different item prohibited in FCCH ,No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

LPA Bailey reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with licensee. *Infants should always sleep on their backs, mouths facing up.*

Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

No deficiencies were observed or cited in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes. At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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: HOUSTON FAMILY CHILD CARE
FACILITY NUMBER: 198010065
VISIT DATE: 11/26/2019
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Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

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

A copy of this report, a notice of site visit and appeal rights exit interview conducted with the licensee .

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
LIC809 (FAS) - (06/04)
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