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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011765
Report Date: 07/19/2021
Date Signed: 07/19/2021 04:11:45 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:ANTONINI FAMILY CHILD CAREFACILITY NUMBER:
198011765
ADMINISTRATOR:ANTONINI, MARLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 420-2396
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:14CENSUS: 12DATE:
07/19/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Marla Antonini, LicenseeTIME COMPLETED:
04:15 PM
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An unannounced Annual Inspection was conducted by Licensing Program Analysts (LPA) Alicia Mooberry. This is a continuation of an annual inspection conducted on 7/13/21. LPA met with licensee Marla Antonini who guided LPA on a tour of the facility. There were 12 children present, including 2 infants. Also present is Brennon Antonini, licensee’s assistant and adult son. All adults present during inspection have obtained the required background clearance.

At 11:20am, LPA observed Child #1 (Infant age 12 months) napping in Master bedroom with door closed. Per licensee, the door had been opened and was closed briefly while she answered the front door. This poses an potential risk to the health and safety of children in care. Licensee was instructed to open the bedroom door, licensee complied and provided direct supervision; the Infant sleep log was complete as well as the LIC 9227 for Child #1.

Areas accessible to children were inspected as follows: Bedroom #1 (by the kitchen), Bedroom#2 (by the bathroom), Master bedroom by the playroom, dining area, bathroom in the hallway, playroom and back yard.
LPA observed 4 preschoolers napping in Bedroom #1, 4 preschoolers and 1 infant napping in Bedroom #2.

Off limit areas include: 1 bedroom, attached garage, side yard, and front yard. Per licensee,
LPA observed fire extinguisher purchased on 7/14/21.
LPA observed a firearm in locked safe. There is a jacuzzi in the backyard behind a locked gate, the jacuzzi is empty and covered with a piece of wood as demonstrated by the licensee. The backyard is adequately fenced with age appropriate toys and covered in artificial grass to serve as cushion. LPA observed a gate on the side of the home blocking entry in the a side yard which contains a grill and propane tank.

Cleaning supplies and sharp items were observed to be kept in high cabinets in the kitchen inaccessible to children in care.


Page 1
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
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: ANTONINI FAMILY CHILD CARE
FACILITY NUMBER: 198011765
VISIT DATE: 07/19/2021
NARRATIVE
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The carbon monoxide detector was tested and found operable. LPA observed smoke detectors in the kitchen and hallway, however, licensee stated they cannot be checked due to it being connected to the alarm. LPA did not test the smoke detectors due to sleeping children.

Licensee has the Parent’s Rights poster and other appropriate forms posted. First Aid/CPR certificate are valid thru February 2023. LPA observe a disaster drill log. Last disaster drill conducted on 4/21. Licensee has a current phone number dedicated to facility.

Children's Roster and children's files were reviewed found to have the LIC 700 Identification information. in file. No fire places or open face heaters were observed. The home has central air and heating.



The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.

· Safe Sleep/Infant Care: Licensee is currently providing care for infants. LPA advised licensee to sleep infants where they can be directly supervised at all times. Infants sleep in living room/main child care area. 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. Licensee has a copy of the Recently Approved Safe Sleep Regulation PIN 20-24-CCP
· 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
Report any unusual incident to the department within 24 hour as well as any changes to the facility, construction, etc.
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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
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: ANTONINI FAMILY CHILD CARE
FACILITY NUMBER: 198011765
VISIT DATE: 07/19/2021
NARRATIVE
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· COVID-19 Guidelines : Licensee and staff was observed not following the current county guidelines regarding face coverings. LPA has provided licensee with the latest guidelines for the L.A. Health Department regarding the use of face coverings and well as provide PIN 21-08-CCP which describe the role of the Community Care Licensing Division's (CCLD's) oversight role during the COVID-19 pandemic. Licensee stated she will not wear a face covering during hours of operation nor will she require her staff or children to wear a mask during hours of operation until she is provided with the mandate or law requiring face coverin gin the Family Child Care Home. This poses a potential risk to the health, safety and personal rights of children in care.

Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D.

LPA advised the Licensee to access forms and regulations on line at: www.cdss.ca.gov

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 Licensee, Marla Antonini. Appeal rights discussed and explained.

End of report - Page 3
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
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: ANTONINI FAMILY CHILD CARE
FACILITY NUMBER: 198011765
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2021
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.
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This requirement is not met as evidenced by:
LPA observed licensee, staff and children not wearing face covering during inspection. Licensee has refused to comply with the LA County Department of Heath guidelines regarding face coverings.
This poses a potential risk to the health, safety and personal rights of children in care.
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Type B
07/19/2021
Section Cited

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The provider shall supervise infants while they are sleeping and adhere to the following requirements: 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 sleeping infant in licensee's bedroom with door closed. Per licensee, the door to the bedroom was closed briefly while she opened the front door. LPA observed Infant log with completed 15 minute checkups and sliding glass door leading to the bedroom. 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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4