198019332-2-15-2023-54-CC-RDEO-CP3QG6-20230215110901

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019332
Report Date: 02/15/2023
Date Signed: 02/15/2023 11:09:11 AM

Document Has Been Signed on 02/15/2023 11:09 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 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: 0	DATE:	02/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Licensee - Yvette Gordon		TIME COMPLETED:	11:25 AM

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 annual inspection to the above facility on 02/15/23. LPA arrived at the facility at 9:15 AM and met with licensee, Yvette Gordon, who guided analyst on a tour of the facility. Also present during this inspection were residents S2 and S3. Per Licensee, there are 10 children that are currently enrolled. There were no children present upon arrival. This is a two-story home which consists of 4 bedrooms, 3 bathrooms, kitchen, dining room, living room, garage, front yard and backyard (fenced). The off limit areas include 4 bedrooms, 2 bathrooms, the kitchen, and garage. Per licensee, the front yard is used occasionally during the summer time, but most outdoor play time occurs in the backyard. The main care area is located in the living room. LPA observed a couch, a wooden locker to store personal belongings, age appropriate toys, a wall mounted television, and a wall mounted air conditioning unit. LPA observed a treadmill in the corner of the living room. LPA did not observed the treadmill to be plugged in or have the key to turn the treadmill on. LPA observed a gate leading upstairs to the off-limit bedrooms and a gate leading to the off limit kitchen. The bathroom is accessed by walking through the off-limits kitchen. LPA observed the bathroom to be clean with an operable sink, toilet, and faucet. Cleaning supplies were observed to be kept in a cabinet beneath the sink in the off-limits kitchen. No sharp or pointy objects were observed to be accessible in the off-limits kitchen area. Per licensee, she provides food for the children in care. The dining room was observed with additional age appropriate toys, child sized tables, child sized chairs, a wall mounted television and art supplies. The backyard was observed with outdoor play equipment, patio furniture and artificial grass. Barbeque grills and outdoor heaters were observed to be covered in the backyard play area. Per licensee, isolation area for children showing signs of illness will be located in the living room while they await parent pickup. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. Emergency Disaster Plan, Parent’s Rights Poster and the (page 1 of 3)

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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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Document Has Been Signed on 02/15/2023 11:09 AM - 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
MONTEREY PARK S WEST, 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: 02/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

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 but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not maintin a fire extinguisher whci meet stardards established by the State Fire Marshall, which poses a potential Health, safety and/or personal rights risk to persons in care.
	POC Due Date: 02/24/2023
	Plan of Correction
1 2 3 4	Licensee states she will email LPA a picture or service tag or purchase receipt of a new fire extinguisher

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: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GORDON FAMILY CHILD CARE	FACILITY NUMBER: 198019332
	VISIT DATE: 02/15/2023

NARRATIVE

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Facility License were observed to be posted at the entrance. LPA did not observe any objects that can pose a danger to children in care. No bodies of water were observed in the back yard play area. There are no pets on the premises. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety,

comfort, and cleanliness. There is telephone service via a landline. Day care area was observed with safe toys, play equipment and materials. The licensee understands that storage areas for poisons must be locked, not just inaccessible. The valve on the required 2A 10BC fire extinguisher indicates fully charged however no service tag or purchase receipt was available. LPA advised licensee that a citation under California Code of Regulation section 102417(g) will be issued. Smoke and carbon monoxide detectors were tested and are operable.

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.

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
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SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GORDON FAMILY CHILD CARE	FACILITY NUMBER: 198019332
	VISIT DATE: 02/15/2023

NARRATIVE

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review.

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. LPA also provided and discussed the Provider Information Notices (PINS) on Recently Approved Safe Sleep Regulations in Effect: PIN 20-24-CCP.

The following deficiency listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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.

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SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC809 (FAS) - (06/04)

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