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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016841
Report Date: 02/13/2020
Date Signed: 02/13/2020 10:38:00 AM

COMPREHENSIVE INSPECTION
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 CAREFACILITY NUMBER:
198016841
ADMINISTRATOR:MOORE, DONICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 220-7683
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:14CENSUS: 2DATE:
02/13/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Donice Moore, LicenseeTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced annual random inspection to ensure the health & safety standards as required by regulations governing family child care homes are being met. Upon arrival, LPA met with Licensee, Donice Moore, who guided on a tour of the facility.

There were 2 children present. Per licensee, there are 7 children enrolled at the moment, however licensee did not have a roster. Per Licensee individuals residing in the home are, Licensee, and 2 adult daughters. LPA confirmed with licensee that all adults residing/working in the home have received criminal record/TB clearances.

The facility is a one story, 3-Bed, 2-Bath home. Per Licensee the following areas are used for day-care: Living room (main day care room), Restroom, den area. Per licensee, she is currently not using the backyard for outdoor play. Per Licensee, Off limit areas include: All Bedrooms, 1 Restroom, detached garage and kitchen. Per licensee, operating hours are Monday-Friday 6am-3am.

Licensee has all appropriate forms posted. Licensee's Pediatric First Aid and CPR certificates are valid thru 07/18/21. Per licensee the last disaster drill was conducted with children on 11/19, verification of drills conducted was provided during today's visit. Licensee has a working home telephone.

There is an operational smoke detector and carbon monoxide detector maintained in the home. The home has electrical outlet covers throughout and maintains a First Aid Kit.

There are adequate age appropriate toys, books, games and materials for children in care. Per Licensee there are no firearms present on the premises. Report Continues 809C

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 6
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: 198016841
VISIT DATE: 02/13/2020
NARRATIVE
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PHYSICAL PLANT
· Detergents, cleaning compounds, medications are kept in overhead cabinet in the bathroom making it inaccessible to children in care.
· Home has open face heaters in the home. Wall heater in the hallway was not barricaded
· The valve on the required 2A 10BC fire extinguisher indicates fully charged however NO service tag was found, Per licensee, she has not serviced it in last 2 years. Smoke and carbon monoxide detectors were tested, and are in operable condition.
· The home is kept clean and orderly.
· The home provides safe toys, play equipment, and materials.

CARE AND SUPERVISION
· When temporary absent from home, the licensee arranges for a substitute adult to care and supervise children in their absence.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided. The licensee is operating within the license capacity limitations.
· Each child has a safe, healthful, and comfortable accommodations, furnishings, and equipment.

ADMINISTRATION AND RECORD REVIEW
· Licensee does not have a current roster of the children enrolled.
· Children’s records of children present were reviewed for completeness.
o Children’s files were incomplete or missing
· Licensee documents immunization records and maintains and updates children’s records. Child missing immunization record
· Notification of Parents’ Rights receipt on file for each children in care.
· All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home.
· The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR.
· Licensee is missing Mandated Reporter Certificate.

Report Continues 809C
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: 198016841
VISIT DATE: 02/13/2020
NARRATIVE
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NO ZERO TOLERANCE deficiencies cited during this visit. Zero Tolerance includes:
· Absence of Supervision.
· Accessible Bodies of Water. No body of water, pool or spa in the home.
· Accessible Firearms, Ammunition or Both. No firearms or weapons in the home.
· Refused Entry to a Facility or Any Part of a Facility in Violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g)(2).
· The Presence of an Excluded Individual. No excluded individuals.
· Children are not left in parked vehicles.

The following items were also discussed with licensee during this visit.
· Dog(s) and or pets are recommended to be isolated from children in care
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
· There are first aid supplies available.
· 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.
· LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back.

Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

Incidental medical services are not currently being provided. Licensee was advised that she must contact the Dept 30 days prior to enrolling a child with IMS needs.



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

Report Continues 809C
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: 198016841
VISIT DATE: 02/13/2020
NARRATIVE
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LPA reviewed and issued the LIC 9232 - 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 visit.

Deficiencies were observed or cited in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes. See 809D

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

Exit interview conducted with licensee, Donice Moore, appeal rights discussed

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: 198016841
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2020
Section Cited

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102417 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... (1)...The home shall contain a fire extinguisher ... which meet standards established by the State Fire Marshal.
This requirement is not met as evidenced by:
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LPA observed fire extinguisher without tag or receipt to indicate last time of service.


This poses a potential risk to the health and safety of children in care.
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Type B
02/28/2020
Section Cited

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102418 Immunizations (a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
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LPA observed during file review that C2 was missing immunizations and C1 did not have a file.

This poses a potential risk to the health and safety ofchildren in care
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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 VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2020
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: 198016841
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2020
Section Cited

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102417 Operation of a Family Child Care Home (g) Safety precautions shall include but not be limited to: (1) Fireplaces and open-face heaters shall be screened to prevent access by children.

This requirement is not met as evidenced by
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LPA observed wall heater in the hallway by bathroom without barrier or barricade.

The poses a potential health and safety risk to children in care.
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Type B
02/21/2020
Section Cited

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102417 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... (8) Each family child care home shall have a current roster of children...
This requirement is not met as evidenced by:
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LPA reviewed files and did not find a current roster.

This poses a potential risk to the health and safety of children in care
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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 VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2020
LIC809 (FAS) - (06/04)
Page: 6 of 6