198014629-7-28-2021-54-CC-RNAO-C5CPEZ-20210728111557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014629
Report Date: 07/28/2021
Date Signed: 07/28/2021 11:16:05 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:	KING FAMILY CHILD CARE		FACILITY NUMBER:	198014629
ADMINISTRATOR:	KING, SHANNON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 437-1451
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	14	CENSUS: 10	DATE:	07/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Shannon King		TIME COMPLETED:	11:35 AM

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) Raul Navarro conducted an unannounced random annual inspection. LPA arrived at 9:24am and met with Licensee Shannon King who guided this LPA on a tour of the facility. Also present was Licensee's assistant. There were 10 children present during today’s inspection. Licensee states that there are currently 13 children enrolled. The Licensee is within the conditions, limitations, and capacity specified on the license. The children's roster was reviewed and is current. This is a one story home which consists of seven bedrooms and two bathrooms. Areas used by the children include the three rooms, one restroom, and fenced back yard. Per Licensee, areas off limits to children and parents include: four bedrooms, one restroom, kitchen, dining room, and living room. The Licensee uses one of the rooms as the designated ill isolation area. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone service maintained in the home. All adults have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Per Licensee, there are no weapons or firearms in the home. LPA did not observe any bodies of water on the premises. There are safe toys, play equipment and materials observed for children. Emergency Disaster Plan was posted at the time of inspection. 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, last serviced on 11/2020. Smoke and carbon monoxide detectors were tested and are in operable condition. The Licensee and assistant have current EMS approved Pediatric First Aid and CPR, which will expire on 10/2022. Report continues- Page 1 of 3

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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: KING FAMILY CHILD CARE	FACILITY NUMBER: 198014629
	VISIT DATE: 07/28/2021

NARRATIVE

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Proof of immunization against influenza, pertussis, and measles for the Licensee and assistants was readily available during today’s inspection. The Licensee and assistants have also taken the Mandated Reporter Training.

Licensee states that she is not currently caring for infants and does not plan on caring for infants. A copy of the new infant sleep regulations and LIC 9227 was provided to Licensee.

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 in care are supervised at all times. When temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise children in their absence.

Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. Infant walkers, johnny jumpers, saucer chairs, trampolines and any other item that falls into that category are not permitted in the facility. Car seats shall only be used for transportation purposes and shall not be used for sleeping. Children shall not be left in parked vehicles. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov.The Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep was provided.

Report continues- Page 2 of 3

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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: KING FAMILY CHILD CARE	FACILITY NUMBER: 198014629
	VISIT DATE: 07/28/2021

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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

LPA issued the Confidential Names List (LIC 811) to the licensee during this visit. The Confidential Names List documents the children’s files that were reviewed during this inspection.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Report ends- Page 3 of 3

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

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