198012858-8-30-2019-54-CC-DCHS-BFJV2X-20190830160353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012858
Report Date: 08/30/2019
Date Signed: 08/30/2019 04:04:13 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:	CLARK FAMILY CHILD CARE		FACILITY NUMBER:	198012858
ADMINISTRATOR:	CLARK, JAUNITTIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 502-0344
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90810
CAPACITY:	14	CENSUS:	DATE:	08/30/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Licensee,		TIME COMPLETED:	04:20 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) Dayna Chambers and Susann Sanchez conducted an unannounced annual random inspection to the above facility. Upon arrival, LPA met with Licensee, Juanita Clark, and daughter, Sandra Clark, who guided analysts on a tour of the facility. The licensee states that 3 adults and 1 child currently live in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, living, or volunteering in the licensed child care home. Per Licensee, there are 8 children that are currently enrolled. There was one child present upon arrival. Licensee states there are 0 infants currently enrolled. LPA observed licensee is operating within the license capacity limitations. Licensee's hours of operation are Monday through Friday, 8am to 5pm. LPA observed there are no firearms, weapons, pets, or bodies of water on the premises. LPA observed the Emergency Disaster Plan, Parent’s Rights Poster, and the Facility License were posted in the living room. A current children’s roster was available for review. This is a one story home which consists of 2 bedrooms, 1 bathroom, kitchen, dining room, living room, front yard (fenced), and backyard (fenced). Off limit areas include: 2 Bedrooms, detached garage and laundry room (locked). LPA inspected back yard and found the detached garage and laundry room locked. There are two wall heaters in the living room area and are barricaded. The licensee does provide food for children in care. All food provided by parents is labeled with child’s name and stored in the refrigerator if needed.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CLARK FAMILY CHILD CARE	FACILITY NUMBER: 198012858
	VISIT DATE: 08/30/2019

NARRATIVE

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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

The following was observed and reviewed during this inspection: All areas identified on the facility sketch that are accessible for children’s use were inspected for safety, comfort, and cleanliness. There is telephone service via cellphone and this cellphone stays at the facility during operation hours. The home is observed to be clean and orderly. LPA viewed safe age appropriate toys and play equipment in the main play area located in living room. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories, these items are not permitted in a family child care facility.

LPA observed the outdoor area in backyard is sometimes used by children. Outdoor play area is fenced in and free from defects or dangerous conditions. The yard was clean with age appropriate safe toys and appropriate shading.

LPA observed during today’s inspection that 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. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Juanita Clark, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CLARK FAMILY CHILD CARE	FACILITY NUMBER: 198012858
	VISIT DATE: 08/30/2019

NARRATIVE

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The children use the bathroom located near living room. The restroom that children use was observed by LPA to be safe and sanitary. LPA observed during inspection that the bathroom and kitchen do not have detergents, cleaning compounds, medications, and other items which could pose a danger to children and these items were stored in locked cabinets and observed to be inaccessible to children. The main play area is located in the living room area and meals and snacks are provided in the kitchen area. LPA observed ventilation with a window air conditioner.

LPA observed the fire extinguisher located in Kitchen. LPA observed the fire extinguisher meets requirements - 2A:10BC. The fire extinguisher indicates fully charged. LPA observed that the smoke and carbon monoxide detectors were tested by licensee and are operable. LPA observed the emergency disaster drill was conducted at least once every six months.

The licensee completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 03/2020. There are first aid supplies available. Children’s records were reviewed and are complete. Licensee provided LPA with a copy of a letter declining influenza immunization dated 01/01/2018. LPA observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. Licensee does admit she smokes outside the home and provided a declaration. Per licensee, IMS services are not currently provided.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CLARK FAMILY CHILD CARE	FACILITY NUMBER: 198012858
	VISIT DATE: 08/30/2019

NARRATIVE

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The following items were discussed with the licensee:

Licensee was reminded it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations. CHILD CARE Advocate: You may contact the Child Care Advocate Program directly: Phone number: (916) 654-1541 Email address: childcareadvocatesprogram@dss.ca.gov

In the absence of the licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.
Smoking is prohibited in a family child care home.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.

Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors, and employees shall complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

Infant Care: LPA advises licensee to sleep infants where they can always be directly supervised and advised against sleeping infants in a separate room.
LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019

LIC809 (FAS) - (06/04)

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