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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010536
Report Date: 05/09/2022
Date Signed: 05/09/2022 12:58:16 PM


Document Has Been Signed on 05/09/2022 12:58 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:TILLMAN FAMILY CHILD CAREFACILITY NUMBER:
198010536
ADMINISTRATOR:TILLMAN, TRACEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 209-8686
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY:14CENSUS: 3DATE:
05/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Tracey Tillman - LicenseeTIME COMPLETED:
01:06 PM
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 Licensing Program Analyst (LPA) Alicia Bailey conducted an unannounced random annual (or Required) inspection today 05/09/2022. LPA met with Licensee Tracey Tillman at 9:10 am, who guided this LPA on a tour of the facility. At 9:35 am during the inspection, LPA Bailey discussed, assessed, and noted individuals residing in the home. The facility Entrance Checklist for Family Child Care Homes was given to Licensee Tillman. This is a one story home consisting of 2 bedrooms and 2 bathrooms. Areas used by the children include the day-care room, one ( bedrooms), one (1) restroom, frontyard and backyard. Per Licensee Tillman and facility sketch, areas off-limits to children include 1 ( one) bedroom, one bathroom, kitchen, and the garage. 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. The Licensee Tillman stated there is no other license held at this facility. There was three children in attendance during the time of inspection. Licensee Tillman states that there are currently fourteen children enrolled. Facility hours of operation are Sunday thru Saturday from 1:00 am to 11:59 pm,

There are NO weapons or firearms in the facility. LPA Bailey observed there was no swimming pool or body of water. At 10:05 am, LPA Bailey observed a first aid kit and fire extinguisher 2A10BC ( need service) in the kitchen. The smoke detectors and carbon monoxide were tested by LPA and are in operable condition.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 198010536
VISIT DATE: 05/09/2022
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At 10:30 am LPA Bailey observed a large television mounted to the wall, age-appropriate toys, and napping equipment in the adjacent day-care rooms. At 10:40 am, LPA Bailey toured the children's bathroom. LPA Bailey did not observe any hazardous items in the bathroom.

At 10:50 am LPA Bailey toured the kitchen ( off-limit). The countertops were clean and free of clutter or standing food. The kitchen cabinets have a safety lock and knives and the medicine was in a secure cabinet. Licensee Tillman provide breakfast, lunch, and snacks.



At 10:56 am, LPA Bailey toured the frontyard and backyard and observed that all areas were adequately fenced and were inspected for hazards.

At 10:59 am, LPA Bailey, reviewed the Disaster Plan; was reviewed. LPA Bailey ask Licensee Tillman when was the last time the facility conduct a fire drill? Licensee Tillman state January 28, 2022. LPA Bailey advise Licensee Tillman to conduct a fire & earthquake drill this month. A current Children's roster was viewed and maintained for a period of 3 years, even after children are no longer attending the facility.

Licensee Tillman has mandated reporter training expired 05/15/2022. LPA Bailey advise Licensee Tillman to renew mandated reporter this week. Licensee Tillman PED F/A & CPR EXP. 11/01/2023.

At 11:08 am, LPA Bailey reviewed fourteen children's files. LPA Bailey observed fourteen children files was in compliance. At 11:13 am, LPA Bailey reviewed three personal files, LPA Bailey observed the three personal files was not in compliance.

Licensee Tillman was advised that regulations prohibit the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation. LPA Bailey reviewed with Licensee Tillman the different items prohibited in FCCH, no baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, no trampolines, and any other items that fall into that category are not permitted in the facility.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC809 (FAS) - (06/04)
Page: 2 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 198010536
VISIT DATE: 05/09/2022
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At 11:23 am, Licensee Tillman was also reminded that only children eating may be in highchairs and that car seats are utilized only for transportation. Licensee Tillman provides transportation for school-age children.

At 11:34 am, LPA Bailey also consulted with Licensee Tillman regarding COVID-19 health and safety guidelines.

At 11:40 am, LPA Bailey conduct a staff interview with Licensee Tillman.

At 11:50 am, the following was discussed with Licensee Tillman, :

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/process.

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.
Infant Needs and Services Plan: The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. Infant Care: LPA advised the applicant to sleep infants where they can be directly supervised at all times. LPA advised against sleeping infants in a separate room. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were email to Licensee Tillman. LPA discussed PIN 20-24-CCP.

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

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
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: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 198010536
VISIT DATE: 05/09/2022
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The licensee Tillman currently not providing Incidental Medial Services currently.

The 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

The following was discussed with Licensee Tillman Individuals who are 18 years of age or older living in the home must be fingerprint 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.

No deficiencies were cited in accordance with 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 citations being issued today.


Upon receipt, Notice of Site Visit shall be posted for thirty (30) days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview was conducted, and a copy of this report was provided to the Licensee Tillman. Notice of site visit was issued.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC809 (FAS) - (06/04)
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