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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011242
Report Date: 06/17/2021
Date Signed: 06/18/2021 05:52:19 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:ELEY FAMILY CHILD CAREFACILITY NUMBER:
198011242
ADMINISTRATOR:ELEY, TAMMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 563-3767
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:14CENSUS: 9DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Tammy Eley, LicenseeTIME COMPLETED:
04:00 PM
NARRATIVE
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THIS IS AN ELECTRONIC COPY OF A WRITTEN INSPECTION REPORT
On 6/17/21 Licensing Program Analyst (LPA ) Alicia Mooberry conducted an unannounced site inspection to the above facility. LPA arrived at 12:01pm and met with Ashley Browner, Assistant, who is cleared and has current 1st Aid/CPR Exp. 09/21. LPA observed 6 children upon arrival. LPA observed required forms posted in a prominent location in the living room (main childcare area).

This is a single story home: 2 bedrooms and 1 bath, kitchen, living room.

At 12:21pm Licensee, Tammy Eley arrived at the facility. Licensee provided tour of the home since assistant was preparing lunch. At 12:32pm LPA observed an infant - Child #1 laying in Licensee's bedroom. The infant is 3 months old and was laying on the licensee's bed surrounded by pillows. The door to the bedroom was closed and Child #1 was alone in the room. This poses an immediate threat to children in care.

Per licensee, Child #1 is her granddaughter and only visiting on this day.
Licensee removed the infant and placed in play

Children's record review revealed that Child #1 does not have a file, No Individual Infant Sleeping Plan (LIC 9227) was found, No infant log found in file. This poses a potential risk to children in care. LPA provided licensee with the following:
- A Child Care Provider's Guide to Safe Sleep
- PIN 20-24-CCP Safe Sleep Regulations


Report Continues on 809C
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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 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: ELEY FAMILY CHILD CARE
FACILITY NUMBER: 198011242
VISIT DATE: 06/17/2021
NARRATIVE
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LPA observed no bodies of water on premises
Facility has central air and heating
The fire extinguisher was serviced on 10/7/20
Detergents, cleaning compounds and other items which can pose a danger to children in care were located in locked cabinet under kitchen sink.
Safe toys and play equipment were observed
Smoke detector and carbon monoxide detector were found operable.
A comprehensive inspection will be conducted on a future date due to LPA having technical issues with equipment.

Deficiencies were cited in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes. See 809D

Whenever a type A is cited: Licensee shall post and provide copies of this report to parent/guardians of childcare children in the facility and of children newly enrolled at the facility during the next 12 months. A signed LIC 9224 Acknowledgement of Receipt of Licensing Reports Form shall be placed in children's file.


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.

Exit interview was conducted with Tammy Eley, Licensee. Appeal rights discussed and explained.


SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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: ELEY FAMILY CHILD CARE
FACILITY NUMBER: 198011242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/17/2021
Section Cited

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The provider shall supervise infants while they are sleeping and adhere to the following: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.
This requirement is not met as evidenced by:

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LPA observed Child #1, an infant 3 months of age, laying on an adult sized bed surrounded by pillows in licensee's bedroom. The bedroom door was closed completely.

This poses an immediate risk to the health and safety of children in care.
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Type A
06/17/2021
Section Cited

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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include...To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
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LPA observed Child #1, an infant 3 months of age, laying on an adult sized bed surrounded by pillows in licensee's bedroom. The bedroom door was closed completely.

This poses an immediate 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2021
LIC809 (FAS) - (06/04)
Page: 3 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: ELEY FAMILY CHILD CARE
FACILITY NUMBER: 198011242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2021
Section Cited

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An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.

This requirement is not met as evidenced by:
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LPA reviewed children's files and found that Child #1 who licensee stated is 3 months old does not have an Infant Plan LIC 9227, nor an Infant sleeping log.

This poses a potential risk to the health and safety of children in care.
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Type B
06/25/2021
Section Cited

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102421 Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).

This requirement is not met as evidenced by:
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LPA reviewed children's files and found that Child #1 does not have a file in the facility. Per licensee, Child #1 is her granddaughter and only visiting.

This poses 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4