198013169-1-26-2022-54-CC-RDEO-CB2T23-20220126132003

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013169
Report Date: 01/26/2022
Date Signed: 01/26/2022 01:20:11 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:	DOUGLAS FAMILY CHILD CARE		FACILITY NUMBER:	198013169
ADMINISTRATOR:	DOUGLAS, SHAKENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 375-3636
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	14	CENSUS: 10	DATE:	01/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Assistant - Tajana Douglas		TIME COMPLETED:	01:35 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) R. Derraco conducted an unannounced required one year inspection to the above facility on 01/26/22 LPA arrived at the facility at 11:15 AM and met with assistant Tajana Douglas, who guided analyst on a tour of the facility. LPA spoke to Licensee, Shakena Douglas, via telephone call and informed LPA that she is currently not present at the facility due to a medical emergency. Per assistant, there are 14 children that are currently enrolled. There were 10 children present upon arrival 2 of which are infants. LPA also observed S2 helping with children in care. This is a 1-story home which consists of 3 bedrooms, 2 bathrooms, kitchen/dining room, living room, front yard and backyard (fenced). The off limit areas include the kitchen/dining room, 2 bedrooms, and a bathroom. A sliding wooden door is used to separate the off limit areas from the day care area in the home. The back yard was observed to have a wooden fence and gate with lock making the area inaccessible to children. The master bedroom has been converted into the main care area. LPA observed the main care area to have a half bathroom, a wall mounted television, storage cubbies for children in care, a locked storage cabinet with children activities and supplies, age appropriate toys, materials, tables and chairs. LPA observed 3 Cosco feeding high chairs model HC225FGT in the main care area. The bathroom that children use was observed to be safe and sanitary. The living room has been converted to care for infants that are enrolled to the day care. LPA observed 5 "Dream on Me" pack an play pens model number 438. A wall mounted television was observed in the infant care room. LPA observed a children's cubby storage cabinet and a Holmes Air purifier against the wall leading to the main care area. A wall mounted air conditioning / heating unit was observed to be built into the wall below the window. A screen was observed to cover the unit making it inaccessible for children in care. The assistant states food is provided for children in care. Per assistant, isolation area for children showing signs of illness will be kitchen/dining area. Currently, children are using the front yard for outdoor play time. The outdoor play area was observed to have perimeter fencing. LPA observed that the (page 1 of 3)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

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 3

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: DOUGLAS FAMILY CHILD CARE	FACILITY NUMBER: 198013169
	VISIT DATE: 01/26/2022

NARRATIVE

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outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children in care. No bodies of water were observed in the front or the back yard area. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs.

Individuals who reside in the home were noted and discussed. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Assistant states that there are no firearms stored in the home. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. Per Licensee, the home was purchased without a furnace. Heat is provided from the wall unit in the infant care room. Day care area was observed with safe toys, play equipment and materials.

Detergents, cleaning compounds, and other items which could pose a danger to children were observed to be beneath the sink in the off limits kitchen. Assistant states that there are no poisons in the home and understands that storage areas for poisons must be locked. No sharp objects were observed to be accessible in the kitchen area.

LPA observed 2A-10BC fire extinguisher to be fully charged with a purchase receipt of 08/26/21.

LPA discussed the safe sleep regulations with assistant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed assistant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. LPAs observed that the Licensee and assistant do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. File review was observed to have proper mandated immunization records. Children’s records were reviewed, including emergency information and were observed to be complete. A current children’s roster was available for review (page 2 of 3)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: DOUGLAS FAMILY CHILD CARE	FACILITY NUMBER: 198013169
	VISIT DATE: 01/26/2022

NARRATIVE

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Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Incidental Medical Services (IMS):
IMS was discussed with licensee. 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Recently Approved Safe Sleep Regulations in Effect: PIN 20-24-CCP, Safe Sleep Awareness Campaign: An example for the Infant Sleep Chart was provided to the licensee

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

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the assistant Tajana Douglas.

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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

LIC809 (FAS) - (06/04)

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