198013467-4-12-2023-33-CC-MGAA-CQU2D2-20230412171739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013467
Report Date: 04/12/2023
Date Signed: 04/12/2023 05:20:06 PM

Document Has Been Signed on 04/12/2023 05:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KAWAI FAMILY CHILD CARE		FACILITY NUMBER:	198013467
ADMINISTRATOR:	KAWAI, NANCY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 728-5437
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY:	14	CENSUS: 7	DATE:	04/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Licensee, Nancy Kawai		TIME COMPLETED:	05:30 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) Mireya García conducted an unannounced annual required inspection. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with assistant, Diana Kawai who guided analyst on a tour of the facility. Also present during LPA’s arrival was licensee’s assistant Cynthia Leon. Licensee Nancy Kawai later arrived during LPAs inspection. There were seven (7) children present with (1) being an infant. Licensee states that there are currently nineteen (19) children enrolled who attend part time/full time. Family members residing in the home are 2 adults (criminal record clearances on file) and 1 minor child. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, laundry room, garage (activity room) and front yard (unfenced) and back yard (fenced). The children use the restroom near the hallway by the bedrooms, living room (main day care room), dining room, kitchen, garage, and back yard. Per licensee, areas off limits to children and parents include: the front yard, laundry room, bedrooms #1, #2 and #3. The LPA toured all areas used by children during this visit. Report continues on next page 1 of 5.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KAWAI FAMILY CHILD CARE	FACILITY NUMBER: 198013467
	VISIT DATE: 04/12/2023

NARRATIVE

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During this tour, the following was noted: At 3:06 p.m., LPA was toured through the interior of the home. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating for safety and comfort. There were safe toys, play equipment and materials observed for children. LPA did not observe any hazards inside of the home. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock.

LPA observed and inspected sleeping equipment for infants. LPA observed one play yard for infant who is unable to climb out of the play yard. All equipment meets the US Consumer Product Safety Commission safety standards. LPA observed that the play yard is free from loose articles and objects. There are no objects hanging above or attached to the side of the play yard. LPA observed that play yard does not hinder the entrance or exit to and from the space they are sleeping in. Mat was observed to be firm and covered with a fitted sheet that is appropriate to the mat size. Per Licensee, the infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers were not observed. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months and PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect was explained and a copy in English was issued to the licensee during this inspection. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the licensee, including but not limited to documentation that shall be maintained.
Report continues on next page 2 of 5.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

Page: 2 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KAWAI FAMILY CHILD CARE	FACILITY NUMBER: 198013467
	VISIT DATE: 04/12/2023

NARRATIVE

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Per licensee, there are no weapons, firearms or bodies of water on the premises. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged with a service tag dated 10/07/2020. LPA advised licensee fire extinguisher needs to be checked and service annually. Smoke detector located in the kitchen and carbon monoxide detector located in the living room were tested and are in operable condition. The licensee disclosed Pediatric First Aid and CPR, expired on 2022. Per licensee, she has enrolled to retake the course for April 27, 2023.

Incidental Medical Services (IMS) policy was discussed. Per Licensee there are currently no children enrolled who required IMS. 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

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee.
AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers
Report continues on next page 3 of 5.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

Page: 3 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KAWAI FAMILY CHILD CARE	FACILITY NUMBER: 198013467
	VISIT DATE: 04/12/2023

NARRATIVE

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The following was discussed:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
The Licensee shall be present in the home and shall ensure that children are supervised at all times.
Children shall not be left in park vehicles.
The capacity specified on the license shall be the maximum number of children for whom care can be provided.
Car seats shall only be used for transportation purposes and shall not be used for sleeping. All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.

Report continues on next page 4 of 5.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

Page: 4 of 11

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KAWAI FAMILY CHILD CARE	FACILITY NUMBER: 198013467
	VISIT DATE: 04/12/2023

NARRATIVE

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LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations. Please refer to LIC809D for documentation of deficiencies cited.

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

Exit interview conducted and report was reviewed with facility representative, Nancy Kawai.

Report ends here page 5 of 5.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

Page: 5 of 11

Document Has Been Signed on 04/12/2023 05:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KAWAI FAMILY CHILD CARE	FACILITY NUMBER: 198013467
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review of last service on fire extinguisher tag dated 10/07/2020. This poses a potential health and safety risk to children in care.
	POC Due Date: 04/21/2023
	Plan of Correction
1 2 3 4	Per Licensee she will take the fire extinguisher to get service on or before POC due date and will send LPA Garcia via email a copy of the service tag by 04/21/2023.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview disclosure from Licensee her Pediatric CPR & First aid expired on 2022. This poses a potential health and safety risk to children in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Per Licensee she and her daycare staff have enrolled in CPR course on 04/27/2023, and will submit proof of completion certificate to LPA Garcia via email by POC due date 04/28/2023.

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 VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

Page: 6 of 11

Document Has Been Signed on 04/12/2023 05:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KAWAI FAMILY CHILD CARE	FACILITY NUMBER: 198013467
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review of child #6's file no record of sleeping logs; Time of each 15 minute check while sleeping, were not available for review. This poses a potential health and safety risk to children in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Per Licensee she will began to visually check sleeping infants every 15 minutes and will record visual check on a sleep log and will submit copies of logs to LPA Garcia via email by POC due date 04/28/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

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