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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016984
Report Date: 06/03/2021
Date Signed: 06/03/2021 11:37:15 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:ENGBERG FAMILY CHILD CAREFACILITY NUMBER:
198016984
ADMINISTRATOR:ENGBERG, TONIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 233-9872
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:14CENSUS: 9DATE:
06/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Toni Engberg - LicenseeTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Alicia Bailey conducted an unannounced random annual (OR Required) inspection. LPA met with Licensee Toni Engberg at 8:00am who guided this LPA on a tour of the facility. Also present was Licensee's two assistants. At 08:05 am during the inspection LPA Bailey discussed and assessed individuals residing in the home. This is a two story home which consists of 4 bedrooms and 5 bathrooms. Areas used by the children include the family room, game room, infant bedroom room, one(1) restroom adjacent patio area, and backyard. Per Licensee, areas off limits to children include: second floor, three (3)bedrooms, four restrooms, kitchen, front yard and garage. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. A parent board with required postings was observed at the entrance of the facility. There were nine children present during today’s inspection. Licensee states that there are currently 18 children enrolled. Licensee provided sign in information through Brightwheel app.

There are NO weapons, firearms in the facility At 8:30 am LPA Bailey observed tour the back yard area observed a swimming pool on the premises. LPA Bailey observed the pool has proper fencing. LPA Bailey toured the backyard observed that all areas is adequately fenced and was inspected for hazards .Outdoor equipment was inspected for safety, good repair and appropriateness. Licensee has a pet three dogs and two cats. Vaccination for pets are current.

At 8:45am LPA Bailey tour the children bathroom. LPA Bailey observed children safety latches on the bathroom cabinet . LPA Bailey did not observed any hazardous items in the bathroom. At 8:50am LPA Bailey toured the kitchen ( off Limit adjacent to family room) the counter tops were clean and free of clutter or standing food. Kitchen Cabinets has safety lock and knives and medicine was in upper secure cabinet. Licensee provides breakfast, lunch and snack.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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: ENGBERG FAMILY CHILD CARE
FACILITY NUMBER: 198016984
VISIT DATE: 06/03/2021
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At 9:00am LPA Bailey observed first aid kit, fire extinguisher 2A10BC in the kitchen .The smoke detectors, carbon monoxide was tested by LPA are in operable condition.

At 9:15 am LPA Bailey observed age appropriate toys and napping equipment on the premises. At 9:21 AM LPA Bailey reviewed the Disaster Plan, Emergency Disaster Drill ( current drill perform on 05/13/2021) were reviewed.

A current Children roster was viewed and maintained for a period of 3 years, even after children no longer are attending the facility.

Children records and required licensing forms were reviewed for completeness. Mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement was reviewed.

Licensee PED F/A & CPR EXP. 01/27/2023

Licensee assistant (staff 1) PED F/A & CPR EXP 09/29/23

Licensee assistant (staff 2) PED F/A & CPR EXP 10/23/23

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

Licensee completed on: 02/2/20

Licensee assistant (staff 1) completed on:11/04/20

Licensee assistant (staff 2) completed on:1/31/20

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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: ENGBERG FAMILY CHILD CARE
FACILITY NUMBER: 198016984
VISIT DATE: 06/03/2021
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Health & Safety Code 1597.622(a1) Employees or volunteers at family day care home; immunization requirements; records; exemptions Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

Licensee has all Immunization's

Licensee Assistant has all Immunization's

Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.

The licensee is not providing Incidental Medial Services at this time.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - 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 Bailey reviewed with Licensee different item prohibited in FCCH ,No baby bouncers, 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 Bailey reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with licensee. *Infants should always sleep on their backs, mouths facing up.*

Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

No deficiencies were observed or cited in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes. At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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: ENGBERG FAMILY CHILD CARE
FACILITY NUMBER: 198016984
VISIT DATE: 06/03/2021
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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.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

****Licensee advised that signing the report does not imply agreement with the findings but is acknowledging receipt of the licensing report.*

A copy of this report, a notice of site visit and appeal rights exit interview conducted with the licensee .

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
LIC809 (FAS) - (06/04)
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