198010536-3-1-2023-54-CC-WBIS-CPHQQC-20230301112206

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010536
Report Date: 03/01/2023
Date Signed: 03/01/2023 11:22:23 AM

Document Has Been Signed on 03/01/2023 11:22 AM - 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 CARE		FACILITY NUMBER:	198010536
ADMINISTRATOR:	TILLMAN, TRACEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 209-8686
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90061
CAPACITY:	14	CENSUS: 4	DATE:	03/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Tracey Tillman		TIME COMPLETED:	11:40 AM

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	Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required - 1 Year inspection. LPA met with Licensee Tracey Tillman who guided LPA on a tour of the facility. Upon arrival, LPA observed the Licensee caring for four preschool children. Per Licensee there are 14 children enrolled (attended at various hours). Individuals residing in the home were noted. The roster is current. At approximately 8:45pm LPA conducted an inspection of all areas of the facility sketch. This is a one story home which consists of two bedrooms, two bathrooms, dining area, kitchen, front yard and backyard. Areas used by children include living room, dining area, one bedroom, one bathroom, front yard and back yard. Per Licensee, areas off limits to children and parents include: One bedroom, one bathroom and the garage. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed toys and play equipment appeared to be safe indoors and outdoors. There is a working telephone maintained in the home. Licensee has no pets and LPA advised Licensee to provide extra care and supervision if she ever decides to get a pet (as animals may be unpredictable). At 8:45am LPA observed hand sanitizer on top of a shelf in an area that LPA deemed semi-inaccessible. LPA informed Licensee to place the sanitizer in an area that is 5ft or higher for more inaccessibility. All other detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in all areas used by children. LPA informed Licensee that poisons must be locked with a key or combination lock. LPA reminded Licensee that all medicines, chemicals, cleaners, nail polish, shampoos, sharp objects, grills, propane, and similar items must be inaccessible at all times. Per Licensee there are no firearms, weapons or bodies of water on the premises and LPA did not observe any on the premises. The Emergency Disaster Plan, Parents Rights and License was posted on a poster board. LPA observed the Licensee has a 2A10BC fire extinguisher on order that is arriving late. The Licensee has a 2A 10BC fire extinguisher that must be serviced or new one purchased in March 3, 2024.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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: TILLMAN FAMILY CHILD CARE	FACILITY NUMBER: 198010536
	VISIT DATE: 03/01/2023

NARRATIVE

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Smoke and carbon monoxide detectors in the bedroom were tested and are in operable condition. LPA observed the Licensee has the current Mandated Reporter training which expires May 14, 2024. LPA observed the Licensee/Staff documentation indicating immunization regarding MMR, DTAP and TB.

At approximately 9:30am LPA reviewed four children's files which include the documentation such as: Parent's Rights, Personal Rights, Affidavit for Liability insurance, Identification and Emergency, Consent for Emergency Treatment, Additional Children in Care, and Immunization records. LPA observed child #1, #3 and child #3 missing immunization records. Note: There are no infants therefore Safe Sleep documents are not required during this time.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present. Licensee's CPR expires January 2025.

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

LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the child's condition. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA discussed the form and explained that the LIC 9227 form that is available on CCLD website.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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: TILLMAN FAMILY CHILD CARE	FACILITY NUMBER: 198010536
	VISIT DATE: 03/01/2023

NARRATIVE

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The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP. LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. Licensee has the required current Mandated Reporter training.

LPA informed Licensee information regarding with Safe Sleep PIN 20-24-CCP. LPA also discussed Entrance Checklist form, Capacity and Ratio, and Items not Permitted. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided.

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. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Tracey Tillman..

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/01/2023 11:22 AM - 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: TILLMAN FAMILY CHILD CARE	FACILITY NUMBER: 198010536
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. 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: LPA observed child #1,3 and 4 missing immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/01/2023
	Plan of Correction
1 2 3 4	Licensee indicated she will provide evidence of immunization records.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC809 (FAS) - (06/04)

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