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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019332
Report Date: 02/28/2020
Date Signed: 02/28/2020 04:28:50 PM

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:GORDON FAMILY CHILD CAREFACILITY NUMBER:
198019332
ADMINISTRATOR:GORDON, YVETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 565-0833
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 5DATE:
02/28/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:58 PM
MET WITH:Yvette GordonTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an Required 1 year inspection. LPA met with Licensee Yvette Gordon who was caring for five preschool children. There are (11) children enrolled. The roster is current.

This is a two story duplex consisting of four (4) bedrooms and three (3) bathrooms. The following areas are used for daycare: Living Room, dining room, one bathroom, enclosed front yard (when no vehicle present), backyard. The backyard is a shared space with a unit in the back. Off limit areas include: One bedroom, a half bath, the garage, and a portion of the backyard. LPA observed empty bouncer in living room.

All areas used by children were inspected for safety, comfort, cleanliness, ventilation and heating (central air and heating). The licensee states that there are no poisons in the home. The licensee understands that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects were inaccessible. Per licensee, there are no weapons, firearms or bodies of water on the premises. There are appropriate toys observed for children. The outdoor play area consist of a shared space with a back unit that is fenced off. The enclosed area appears to be free of hazards at this time. LPA observed a covered grill in the outdoor area. LPA informed Licensee to always ensure that all propane tanks and any other potential hazards cars are inaccessible to children. The Licensee's 2A 10BC fires extinguisher is fully charged and is due for service or new purchase in February 28, 2021. Smoke and carbon monoxide detectors in the home were tested and are in operable condition. There are emergency supplies on the premises and a first aid kit. The Licensee was informed to contact the department for any new construction or changes.



The licensee understands that in her absence a qualified adult who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance (associated to the facility) can care for children. The licensee's pediatric CPR expires in March 24, 2021. LPA observed children's files to be complete and contain Identification and Emergency forms, Immunization Records and Parent's Rights.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
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: GORDON FAMILY CHILD CARE
FACILITY NUMBER: 198019332
VISIT DATE: 02/28/2020
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There were NO ZERO TOLERANCE deficiencies cited during this visit. Zero Tolerance includes:
Absence of Supervision; Accessible Bodies of Water. No bodies of water on the premises; 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.

POSTING REQUIREMENTS: Parent’s Rights Poster, Facility License and Emergency Disaster Plan is posted. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME. 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.

INFANT CARE: LPA advised the licensee to sleep infants where the infant can be directly supervised. If the licensee chooses to sleep infants in another room, the licensee is advised to conduct periodic checks. LPA discussed the following. 1) Safe Sleeping Poster (www.sidsandkids.org).

Medication: 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.

UPDATE: H&S 1597.622: 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. All adults have the required immunizations.

Beginning January 1, 2018, Health and Safety Code 1596.8662 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.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: GORDON FAMILY CHILD CARE
FACILITY NUMBER: 198019332
VISIT DATE: 02/28/2020
NARRATIVE
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Effective January 1, 2018: Existing licensees must meet requirements by March 30, 2018. Preventive (OCAP) online training modules are free of cost and available at http://www.mandatedreporterca.com/. Licensee and staff provided the evidence of the required Mandated Reporter Training (2/13/2020).

LPA informed licensee of Items not permitted in Licensed facility (Napping Rockers, bouncers, car seats). In addition stairs require barricade when children under 5 are present.

LPA also advised Licensee to always make ensure that items such as medicines, perfumes, cosmetics, mouth wash, shampoos, lotions are always inaccessible to children. Inaccessibility means locked away or out of reach if they are placed in a high storage area (5 feet or higher).

The Notice of Site Visit (LIC 9213) and Licensing Report– 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 $100.00 civil penalty. Exit interview conducted with Licensee Gordon.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GORDON FAMILY CHILD CARE
FACILITY NUMBER: 198019332
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2020
Section Cited

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Personal Rights: These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by: LPA observed a bouncer type play equipment in the living room. This poses a potential risk for 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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2020
LIC809 (FAS) - (06/04)
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