198016984-1-31-2023-54-CC-MAYA-CNLTUR-20230131140245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016984
Report Date: 01/31/2023
Date Signed: 01/31/2023 02:02:55 PM

Document Has Been Signed on 01/31/2023 02:02 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:	ENGBERG FAMILY CHILD CARE		FACILITY NUMBER:	198016984
ADMINISTRATOR:	ENGBERG, TONI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 233-9872
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY:	14	CENSUS: 9	DATE:	01/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Licensee, Toni Engberg		TIME COMPLETED:	02:15 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	On January 31, 2023 at 11:50 AM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Toni Engberg. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 6:30 AM to 5:30 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, the Licensee, two (2) Assistants, and nine (9) children were present. All areas identified on the facility sketch were inspected. This facility is a two-story home that consists of four (4) bedrooms, 4.5 restrooms (powder room), living room, family room, game room, dining room, library room, kitchen, detached garage, fenced backyard, and fenced pool area (located in backyard). Areas that are accessible to children include: one (1) powder room (restroom), living room, family room, game room, dining room, kitchen, and fenced backyard. Per Licensee, the children utilize the fenced backyard for outdoor activity. Areas off-limits to children include: 4 bedrooms, 4 restrooms, library room (located upstairs), detached garage, and fenced pool area located in the backyard. LPA observed master bedroom door closed, making the off-limit areas inaccessible to children in care. LPA also observed a child safety gate installed on the bottom of the stairs, making the stairs and upstairs inaccessible to children in care. Licensee was advised that off-limit areas must be made inaccessible during operating hours or while children in care are present. The following documents were posted in a prominent, publicly accessible area: Facility License, Waiver, Notification of Parents' Rights (PUB 394), and Emergency Disaster Plan (LIC 610A). Licensee has a current Facility Roster available for review. Licensee has verification of Disaster and Fire Drills available for review. The last disaster drill was conducted on January 10, 2023 and fire drill on August 26, 2022.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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: 01/31/2023

NARRATIVE

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Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home does not have any wall heaters. LPA observed a screened fireplace located in the living room. Per Licensee, the fireplace is currently inoperable and not used. The home is equipped with central air and heating. Detergents, cleaning compounds, and medicines were made inaccessible to children. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock.

Per Licensee, the home has 4 small dogs, 2 cats, and chickens. LPA observed a gated area on the side of the house where the chickens are kept, and is inaccessible to children in care. LPA advised the Licensee that best practice is to keep pets isolated from children in care. LPA observed a pool that is gated in the backyard. Based on LPA's observations, the waiver on file for the pool was being followed by the provider. Per Licensee, there are no firearms and/or weapons on the premises. LPA observed age appropriate toys and napping equipment for children. LPA also observed electrical outlet covers installed in the child care areas.

LPA observed the required fire extinguisher (2-A:10-B:C) that is fully charged and was purchased on April 22, 2022. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detector and carbon monoxide detector were tested and are operable. First Aid kit and emergency supplies are available and kept in the backyard patio. Licensee was reminded that food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review of five (5) children's records and 3 personnel records. Based on the children's record review, 2 out of 5 children's records (C2 and C3) did not have a completed Affidavit Regarding Liability Insurance (LIC 282) available for review. Licensee utilizes the Brightwell application to document the 15-minute physical checks while infants are napping (records were reviewed). Licensee's Assistants (Staff (S1) and S2) had a complete personnel record per licensing regulations. S1 has a valid Pediatric First Aid and CPR certification (expires October 21, 2022).

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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: 01/31/2023

NARRATIVE

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Based on Licensee's record review, Licensee has proof of immunization against measles, pertussis, and a TB clearance. Licensee has a decline declaration statement for influenza. Licensee renewed her Pediatric First Aid and CPR online on April 28, 2022 and is scheduled to complete the in-person training on February 11, 2023 (verification was reviewed). Licensee completed the Preventative Health and Safety Practices (EMSA-approved) training on May 13, 2012 and Mandated Reporter Training (AB 1207) on April 14, 2022. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage 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.

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 reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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: 01/31/2023

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platforms.

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/inspection-process.

Deficiency was cited during today's inspection (refer to deficiency page).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Toni Engberg.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/31/2023 02:02 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 5 children's records (C2 and C3) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/03/2023
	Plan of Correction
1 2 3 4	Licensee will obtain a completed Affidavit Regarding Liability Insurance (LIC 282) for C2 and C3, and submit proof of completion to LPA via e-mail by March 3, 2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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