198012005-2-8-2023-33-CC-NTCG-CNURBS-20230208115312

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012005
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:53:19 AM

Document Has Been Signed on 02/08/2023 11:53 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	BUTLER-ELDER FAMILY CHILD CARE		FACILITY NUMBER:	198012005
ADMINISTRATOR:	BUTLER-ELDER, SHIRLETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 296-0133
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	14	CENSUS: 5	DATE:	02/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Shirlette Butler-Elder - Licensee		TIME COMPLETED:	12:10 PM

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) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 10:05am LPA met with licensee, Shirlette Butler-Elder. The licensee states that she currently has 8 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 6am-6pm, Monday-Friday. This a two story home which consists of 2 bedrooms, 2 bathrooms, kitchen, dining room, living room (No FIREPLACE), garage and backyard (fenced). The children use living room, dining room area, kitchen and backyard. Per licensee, areas off limits to children and parents include: front room, and upstairs area. All areas identified on the facility sketch were inspected. The licensee provides food for children in care. The licensee states that 2 adults and 0 children currently live in the home. All persons in the home are identified on the attached LIC811. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises. PHYSICAL PLANT At 10:10am, LPA was lead on a tour of the facility by the licensee. Upon entry into the home, the living room and dining room are adjacent to each other. LPa observed Emergency Disaster Plan, Parent’s Rights Poster and the Facility License on a tri-fold poster board. There are age appropriate toys and equipment for the children in care to use. The tour continued in the kitchen where the cabinet under the sink is covered with a safety latch. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. Sharp knives are high on a shelf and out of reach of children in care. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. There was a first aid kit present on the kitchen counter. REPORT CONTINUES PAGE 1 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BUTLER-ELDER FAMILY CHILD CARE	FACILITY NUMBER: 198012005
	VISIT DATE: 02/08/2023

NARRATIVE

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At 10:20am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 01/31/2023, as noted on receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. The tour continued into the play room which is left out of the living room. There are plenty of age appropriate toys present for children in care. There is a bathroom in the play room that is safe, sanitary, and free of hazards. The stairs to the upstairs have a child safety gate keeping children in care from going up. The tour continued to the backyard which is currently used as a play area. There is soon to be construction on the back yard and part of the house due to water damage. LPA reminded licensee to submit an unusual incident report for the start of the renovation. The back yard is observed to be fenced. The licensee currently conducts neighborhood walks with the children and states they use visual supervision at all times. LPA observed napping equipment in the form of sleeping bags. Equipment is stored in play room. Smoke and carbon monoxide detectors were tested and are operable. The licensee is observed to be operating within the license capacity limitations. Per licensee, the front door area will be used as an area for an ill child until an authorized representative comes to pick up child.

FACILITY RECORDS:

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 07/2023. Licensee was unable to proved the proof of Mandated Reporter Child Care Provider. The certificate is on her daughter's email and will be sent to LPA. A Technical Violation is being issued for the inspection. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information speciﬁed by regulation.

The following was 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.
-There are no pets on the premises.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

RERORT CONTINUES PAGE 2 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BUTLER-ELDER FAMILY CHILD CARE	FACILITY NUMBER: 198012005
	VISIT DATE: 02/08/2023

NARRATIVE

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Infant Care: Licensee states that they are not caring for infants at this time. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. 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. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):

The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

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 advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Licensee Shirlette Butler-Elder, at 11:48am. Copy of report provided.
END OF REPORT PAGE 3 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC809 (FAS) - (06/04)

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