198016300-11-19-2019-54-CC-TTRN-BJ3PBA-20191119101000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016300
Report Date: 11/19/2019
Date Signed: 11/19/2019 10:10:07 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:	MOORE FAMILY CHILD CARE		FACILITY NUMBER:	198016300
ADMINISTRATOR:	MOORE, DAYNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	5629232955
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	14	CENSUS: 6	DATE:	11/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Licensee's Employee		TIME COMPLETED:	10:20 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 Analysts (LPAs) Tiffanie Tran and Katrina Chicote conducted an annual random inspection at the above facility. Upon arrival, LPA met with licensee's employee with 6 children in care. Per employee stated, licensee is currently away from due to personal errands. LPA observed proper care and supervision of children and ratios. About 9:20 a.m. licensee arrived home. This is a single dwelling home consists of 4 bedrooms, 2 bathrooms, family room, dinning room, kitchen, and den room. Child care conducted in den and one converted bedroom for play room. Children do have access one bedroom that was set up for naptime. The rest of the areas in the home are off-limits to children. Licensee acknowledged that children may never enter these off-limit areas. Per licensee, children play in the backyard. LPA observed to be fenced in, safe and clean. There are no bodies of water in the home. LPA observed a Labrador in the yard. LPA observed all posting requirements by the entrance. Licensee had current CPR/First Aid certificates expired, fire extinguisher, carbon monoxide and smoke detector meet regulations. Cleaning materials and medications are inaccessible, there is a working telephone, and toys appear to be safe. Licensee stated there are no fire arms in the home. Employee stated they conducted emergency disaster drill on a monthly basis however, failed to proof. LPA reviewed children's record and none of the children's immunization were observed. Licensee and employee failed to show proof of current CPR and first aid certificate and mandated reporter online training. 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 Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198016300
	VISIT DATE: 11/19/2019

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LPA reminded that it is the facility responsibility to know the regulations as well as anyone who assists in providing care. LPA advised on how to access quarterly reports, forms, and regulations for Child Care online at www.cdss.ca.gov. to stay informed of any changes or updates to the regulations.
LPA shared the Child Care Advocate Program (CCAP) participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. Facility may also register on CCAP website for the new quarterly report to be notified. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541. Email address: childcareadvocatesprogram@dss.ca.gov
Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
LPA discussed and provided the safe sleep for baby pamphlet. Each infant shall be constantly supervised and under direct visual observation by an adult person at all times. Under no circumstances shall any infant be left unattended. In order to visually observed and supervise sleeping infants there should be no obstruction to the view of the infants, which could include transparency walls and/or half walls. LPA recommend that infants sleep safest in crib with no bumpers, pillows, blankets, or toys, and on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep-related causes of infant death.
The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

Licensee is reminded that smoking is prohibited on the premises during hours of operation.

Type B deficiencies were cited during today’s visit. An exit interview conducted. Licensee had a copy of this report.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198016300
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/19/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/29/2019 Section Cited	1 2 3 4 5 6 7	Immunizations This requirement is not met as evidenced by based on record review facility failed to obtain children's immunization record for children #1 through #6 which poses a potential health and safety risk to children in care.
Type B 11/29/2019 Section Cited	1 2 3 4 5 6 7	CPR and FIrst Aid This requirement is not met as evidenced by based on record review licensee and employee failed maintain current CPR and First Aid which poses a potential health and safety risk to children in care.
Type B 11/29/2019 Section Cited	1 2 3 4 5 6 7	Mandated Reporter Based on LPAs record review this requirement has not been met as evidenced by Licensee and Licensee Assistant provided no proof of Mandated Reporter Certification. This poses a potential risk to the health and safety of children in care.
	1 2 3 4 5 6 7

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: Trevino Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

LIC809 (FAS) - (06/04)

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