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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011388
Report Date: 03/09/2020
Date Signed: 03/09/2020 01:13:25 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PATRICK FAMILY CHILD CAREFACILITY NUMBER:
198011388
ADMINISTRATOR:PATRICK, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 441-4418
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:14CENSUS: 5DATE:
03/09/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Michelle Patrick TIME COMPLETED:
01:28 PM
NARRATIVE
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On 03/09/20 LPA conducted a unannounced Case Management - Other inspection, LPA met with Licensee Michelle Patrick.

During a visit to the facility on 03/09/20 the following was observed and is being cited in accordance with Title 22, California Code of Regulations:

On 03/09/20 LPA observed that Staff #1 did not have proof of the required TB immunization.

The notice of site visit shall be posted where the parent/guardian of children enter and exit the facility. This notice shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Licensee Michelle Patrick, Notice of Site Visit and Appeal Rights were given.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020
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 2
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 198011388
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/09/2020
Section Cited

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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center 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. This requirement is not met as evidenced by:
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Based on interview Staff #1 is missing proof of the required TB immunization, which poses a potential Health, Safety or Personal Rights risk to 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: Valarie CookTELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2020
LIC809 (FAS) - (06/04)
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