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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012488
Report Date: 04/24/2019
Date Signed: 07/25/2019 11:10:09 AM

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:COOK FAMILY CHILD CAREFACILITY NUMBER:
198012488
ADMINISTRATOR:COOK, AMBERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 701-3931
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:14CENSUS: 9DATE:
04/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Amber Cook, LicenseeTIME COMPLETED:
12:35 PM
NARRATIVE
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THIS IS A TYPED COPY OF THE HANDWRITTEN REPORT THAT WAS PROVIDED TO LICENSEE
Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced annual random inspection to the above facility. LPA met with Amber Cook, Licensee, who guided analyst on a tour of the facility. Also present during this inspection was Maria Verdin, Assistant. Per Licensee, there are 14 children currently enrolled. A current children's roster was available for review. There were 9 children present upon arrival.

This is a one-story home which consist of 3 bedrooms, 2 bathrooms, living room, dining room, den, kitchen, 2 play rooms and backyard. The children use the restroom in the hallway. Per Licensee, areas off-limits to children and parents include: All 3 bedrooms and 1 restroom. The Licensee provides food for children in care.

Per Licensee, 1 adult and 1 child currently reside in the home. Licensee currently has 2 assistants. Licensee states that there are no firearms stored in the home.

All areas on the facility skecth that are accessible to children were inspected. There is telephone service via a cellphone. There is ventilation and heating (central).

When inspecting the bathroom, LPA observed that the latches under the sink are not latching. Licensee was advised to remove the window cleaner and clorox wipes observed under the sink (pictures were taken). LPA observed that there is a step stool in front of the sink, however, LPA informed Licensee that the stool can be easily moved and since the latches are not locking the cabinet doors, it can pose a danger to children. Licensee states that there are no poisons in the home.

There are toys available for children to play with. Mats and play pens were observed for sleeping arrangements.
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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
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 6
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: COOK FAMILY CHILD CARE
FACILITY NUMBER: 198012488
VISIT DATE: 04/24/2019
NARRATIVE
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LPA advised Licensee to access forms, regulations and quarterly updates on line at www.ccld.ca.gov.

Based on the LPAs observations and records review, the following deficiencies listed on the deficiency pages are being cited in accordance with California Code of Regulations Title 22.

The Notice of Site Visit must remain posted for 30 days. Failure to maintain posting will result in a civil penalty of $100.00.

Exit interview was conducted with Amber Cook, Licensee, including but not limited to Appeal Procedures and agency's consultative role.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: COOK FAMILY CHILD CARE
FACILITY NUMBER: 198012488
VISIT DATE: 04/24/2019
NARRATIVE
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There is a fireplace in the living room and it is barricaded. The valve on the fire extinguisher reads fully charged, however, the Fire Marshall tag indicates that it was last serviced on April 22, 2014. LPA advised the Licensee in regards to having the 2A10BC fire extinguisher serviced annually. Smoke and carbon monoxide detectors were tested and are operable.

When inspecting the kitchen, LPA observed that the Licensee has latches on the drawers and cabinets but they are not latching appropriately. LPA observed that the knives can be accessible due to the faulty latches. This poses a potential health and safety risk to children in care.

The Licensee's Pediatric 1st Aid and CPR expires 7/26/19. There are 1st Aid supplies available.

Children use the backyard for outdoor play time. The outdoor area was observed to be fenced. LPA advised the Licensee to remove or store the waterhose on the yard since it can pose a tripping hazard.

Children's records were reviewed. Child #5 & #6 did not have immunization records on file.

In review of staff records, Licensee and Assistant did not have proof of Immunization Records. Assistant, also did not have proof of the Mandated Reporter AB 1207 compliant training certificate.

The disaster drill log was not available for review. LPA advised the Licensee to print the log and update a log in order for it to be readily available upon Department's request. The required forms to be posted were observed to be available but not all were posted. LPA advised the Licensee to make sure that postings always stay posted where they are visible to parents and guardians and/or licensing. LPA advised Licensee to replenish some of the forms since they are faded and need to be updated.

Licensee is caring for infants. Per Licensee, the infants sleep in play pens in the Play Room and are constantly supervised. LPA provided licensee with a copy of the Child Care Provider's Guide to Safe Sleep, SIDS, Never Shake a Baby, Safe Sleep, and updated Parent's Rights Poster.

IMS was discussed.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: COOK FAMILY CHILD CARE
FACILITY NUMBER: 198012488
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2019
Section Cited
HSC
1596.8662(c)
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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
Current proof of completion for each licensed child care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.

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Per Licensee, Assistant will take the Mandated Reporter Training and submit a copy of the certificate.
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This requirement is not met as evidenced by LPA observing that the Assistant does not have proof of the Mandated Reporter AB 1207 compliant certificate. This poses a potential health and safety risk to children in care.
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Type B
05/08/2019
Section Cited
CCR
102417(g)(9)(A)(1)
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Operation of a Family Child Care Home
Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care
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Per Licensee, a disaster drill will ne conducted and log will be submitted by POC due date.
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This requirement is not met as evidenced by LPA not observing a disaster drill log. This poses a potential health and safety 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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: COOK FAMILY CHILD CARE
FACILITY NUMBER: 198012488
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2019
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home

The home shall be free from defects or conditions which might endanger a child.

This requirement is not met as evidenced by LPA observing latches in the kitchen and bathroom that are not securely
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Per Licensee, new latches will be placed.
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locking which can make glassware, knives, cleaning compounds aceesible. This poses a potential health and safety risk to chidlren in care.
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Type B
05/08/2019
Section Cited
CCR
102417(g)(1)
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Operation of a Family Child Care Home

The home shall contain a fire extinguisher and smoke detector device which meets standards established by the State Fire Marshal.

This requirement is not met as evidenced by
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Per Licensee, a new fire extinguisher will be purchased or serviced.
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LPA that the fire extinguisher has not been serviced annually. This poses a potential health and safety 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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: COOK FAMILY CHILD CARE
FACILITY NUMBER: 198012488
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2019
Section Cited
CCR
102418(g)
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Immunizations

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.
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Per Licensee, copies of Child #5 & #6's immunization records eill be submitted by POC due date.
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This requirement is not met as evidenced by LPA observing that Child % & #6 do not have immunization records. This poses a potential health and safety risk to children in care.
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Type B
05/08/2019
Section Cited
HSC
1596.7995(c)
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Employees or volunteers at day care center; immunization requirements; records; exemptions

The day care center shall maintain documentation of the required immunizations. LPA did not observe records for Licensee and Assistant . This poses a
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Per Licensee, Licensee & Assistant will provide copies of immunization records.
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potential health and safety 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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6