198014629-8-3-2021-33-CC-RNAO-ATKUYA-20171129145937

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014629
Report Date: 11/29/2017
Date Signed: 08/03/2021 10:49:43 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 CNTR DR. 200-B
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: 8	DATE:	11/29/2017
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Shannon King		TIME COMPLETED:	03:16 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) Raul Navarro conducted an unannounced three year required inspection. LPA met with Licensee who guided this LPA on a tour of the facility. There were eight children present during today’s inspection. Licensee states that there are currently nine children enrolled. The children's roster was reviewed and is current. Disaster drill log was also available during today’s inspection. This is a one story home which consists of 7 bedrooms, 2 restrooms, and fenced backyard. Per licensee, areas off limits to children and parents include four bedrooms, two bathrooms, kitchen, dining room, and living room . The primary care is done in three rooms, one bathroom and the back yard. 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 maintained in the home. Family members residing in the home are 3 adults (criminal record clearances on file) and one child. There is a pet cat. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Licensee states that there are no poisons in the home. Per licensee, there are no weapons, firearms or bodies of water on the premises. There are safe toys, play equipment and materials observed for children. Emergency Disaster 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, serviced 10/2017. Smoke and carbon monoxide detectors were tested and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire on 08/05/2018. Proof of immunization was readily available during today's inspection. Report continues- Page 1 of 3

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2017

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2017

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE	FACILITY NUMBER: 198014629
	VISIT DATE: 11/29/2017

NARRATIVE

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The licensee’s email address was obtained during this inspection. The licensee was advised that email is public information.

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: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2017

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2017

LIC809 (FAS) - (06/04)

Page: 3 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE	FACILITY NUMBER: 198014629
	VISIT DATE: 11/29/2017

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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.

Rooms that are off-limits need to be made inaccessible during operating hours. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. 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.

LPA reviewed and issued the LIC 311D - 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, criminal record transfer requirements, criminal record and child abuse clearances were also discussed during this inspection.

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.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

Incidental Medical Services (IMS): The Licensee states that she will not administer any medication. If the Licensee chooses to administer prescription medication in the future, she must refer to California Title 22 Regulations Section 102417 for additional information on regulatory requirements.

Report continues- Page 2 of 3

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2017

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2017

LIC809 (FAS) - (06/04)

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