198016496-9-26-2022-54-CC-SSAZ-CJMUJK-20220926153741

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016496
Report Date: 09/26/2022
Date Signed: 09/26/2022 03:37:49 PM

Document Has Been Signed on 09/26/2022 03:37 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	ELLIOTT FAMILY CHILD CARE		FACILITY NUMBER:	198016496
ADMINISTRATOR:	ELLIOTT, YOLANDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 618-9132
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	14	CENSUS: 6	DATE:	09/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Yolanda Elliott, Licensee		TIME COMPLETED:	03:58 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 Analysts (LPA) Susann Sanchez conducted an unannounced annual required inspection at the above facility on 9/26/22 at 1:40 PM. LPA met with Dominique Thompson, assistant who guided analysts on a tour of the facility. There were 5 children, 1 infant and assistant Thompson present when LPA arrived. Facility capacity is in compliance for a large Family Child Care Home. Hours of operation are Mon-Fri 8AM-6PM. Hours may change per parents request. Licensee provides food for the children. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. Licensee arrived around 2:30pm and walked LPA to the "off limit" area of the backyard where there is a jacuzzi. This area of the backyard is gated off. The jacuzzi is blocked off and there are gates on both sides of the side yard. LPA also observed a heavy cover with locks on top of the jacuzzi. Per Licensee there are no firearms on the premises. This is a two-story home which consists of five bedrooms, four bathrooms, kitchen, dining room, office, den, living room, learning room, and side-yards (2) backyard and front yard. The children use the the learning room, two nap rooms, bathroom in the hallway, the bathroom on the right nap room, living room, dining room area, front and side yard. Per licensee, areas off limits to children and parents include: upstairs, office, den and garage. The back yard and right side yard of the house is also off-limits. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: There is a small dog in the home.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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: ELLIOTT FAMILY CHILD CARE	FACILITY NUMBER: 198016496
	VISIT DATE: 09/26/2022

NARRATIVE

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LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 9/06/22.

Smoke and carbon monoxide detector were tested and are operable. LPA observed required 2A10BC fire extinguisher, last serviced 5/26/2022. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There age appropriate equipment, toys and material available for children. LPA observed that detergents, cleaning compounds, knives and medication are stored in the off limits kitchen and a locked storage in the hallway closet, inaccessible to children. Isolation area for sick children waiting to be picked up is in the nap room, away from the other children.

Infant Care: Licensee is has 2 infants enrolled and 1 was present during inspection. LPA advised to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. The licensee states the following as a supervision plan for infants: Licensees states that infants will sleep in the nap room. LPA advised Licensee physically check on sleeping infants every 15 minutes and document whether there is labored breathing, signs of distress, and sleep position (on their backs) . Licensee has a camera in the infant nap room. LPA reviewed and provided PIN 20-24, LIC 9227, and a sample of a sleep log.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment and, LIC 995A Notification of Parents’ Rights.

Staff records were reviewed for approved Pediatric First Aid and CPR certification (expires 08/24), LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate (expires 08/24).

LPA observed that licensee is implementing COVID-19 precautions and procedures.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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: ELLIOTT FAMILY CHILD CARE	FACILITY NUMBER: 198016496
	VISIT DATE: 09/26/2022

NARRATIVE

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Incidental Medical Services (IMS):
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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA's observations and records review no deficiencies will be cited today 9/26/22.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Yolanda Elliott. Appeal Rights were given and explained.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC809 (FAS) - (06/04)

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