198019332-4-8-2022-54-CC-RDEO-CDATKM-20220408144809

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019332
Report Date: 04/08/2022
Date Signed: 04/08/2022 02:48:21 PM

Document Has Been Signed on 04/08/2022 02:48 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:	GORDON FAMILY CHILD CARE		FACILITY NUMBER:	198019332
ADMINISTRATOR:	GORDON, YVETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 565-0833
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	14	CENSUS: 5	DATE:	04/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensee - Yvette Gordon		TIME COMPLETED:	03:00 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 Analyst (LPA) R. Derraco conducted an unannounced required 1 year inspection to the above facility on 04/08/22. LPA arrived at the facility at 01:15 PM and met with licensee Yvette Gordon, who guided analyst on a tour of the facility. Also present during this inspection was S2. Upon arrival, LPA observed a signed posted on the front door indicating that the child care was closed from 04/04/22 to 04/08/22. Per licensee, she has closed facility for personal reasons and the only children in care are her grandchildren visiting for the week. LPA observed 5 total children in care. Per Licensee, there are 8 children that are currently enrolled. This is a two story home which consists of 4 bedrooms, 3 bathrooms, kitchen, dining room, living room, a garage, front yard and backyard (fenced). The off limit areas include the living room, 4 bedrooms, 2 bathrooms, kitchen, garage and front yard. The dining area has been converted into the main care area. LPA observed a wall mounted television, sleeping cots, a child sized table with child sized chairs, several age appropriate toys, children reading materials and children art supplies. A child gate was observed to separate the main care area from the off limits kitchen area. The bathroom designated for children in care was observed to be clean and free of defects. Access to the bathroom is located through the off limits kitchen. A child gate was observed to cover the stairs preventing access to the off limits bedrooms. Per licensee, she has ordered an additional gate to prevent access from the main care area to the off limits living room. The outdoor play area is located in the back yard. LPA observed child sized outdoor play equipment, child sized chairs, and additional age appropriate toys. The licensee states that she provides food for children in care. Per licensee, isolation area for children showing signs of illness will be located in the living room where they are supervised until parent pick up. (PAGE 1 OF 3)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

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 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: 04/08/2022

NARRATIVE

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Individuals who reside in the home were noted and discussed. 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. Licensee states that there are no firearms stored in the home. There is telephone service via a landline. Per Licensee, the home is equipped with central heating and air conditioning. An additional wall mounted A/C unit was observed in the off limits living room. Per licensee, detergents, cleaning compounds, and other items which could pose a danger to children are kept in the off limits garage. The valve on the required 2A 10BC fire extinguisher indicates fully charged however a service tag or a purchase receipt was unavailable. LPA advised licensee to service fire extinguisher or purchase a new fire extinguisher and retain the receipt. Smoke and carbon monoxide detectors were tested and are operable. A pull down fire alarm was observed at the entrance of the facility. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. No bodies of water were observed on the premises. Per licensee, she does not own any pets. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the entrance of the facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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. Per licensee, she does not have any infants enrolled and does not plan to enroll any in the future.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 01/2024 LPA observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. File review was observed to have proper mandated immunization records. A current children’s roster was available for review.

(PAGE 2 OF 3)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

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
	VISIT DATE: 04/08/2022

NARRATIVE

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Incidental Medical Services (IMS):
IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights provided, and report was reviewed with the licensee Yvette Gordon.

(PAGE 3 OF 3)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

LIC809 (FAS) - (06/04)

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