198020847-8-30-2021-33-CC-NTCG-C6DUPJ-20210830154538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020847
Report Date: 08/30/2021
Date Signed: 08/30/2021 03:45:52 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	HARRIS FAMILY CHILD CARE		FACILITY NUMBER:	198020847
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	08/30/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Lily Harris - Applicant		TIME COMPLETED:	04:05 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) Nolan Tcheng conducted a pre-licensing inspection today. At 2:00pm, LPA met with Lily Harris, Applicant who guided analyst on a tour of the facility. This is a change of location application. Family members living in the home were noted on attached LIC811. The applicant is requesting a small family child care home license. Per applicant, operation hours will be Monday to Friday, 8:00am to 6:00 pm. Applicant states she will care for children 0-6 years old. Licensee was previously licensed with facility number 198019564 at 413 Cameron Pl. Glendale, CA 91207. All areas identified on the facility sketch were inspected. This is a one story house. The home consists of 3 bedrooms, 2 restrooms, living room, laundry room, dining room, kitchen, garage converted into a play space, outdoor shed, backyard, and front yard. Areas that are accessible to children are as follows: Bedroom #3, laundry room, bathroom connected to Bedroom #3, converted garage, backyard, and front yard Areas off limits based on facility sketch submitted to children and parents include: Living room, dining room, kitchen, bedroom #1 & #2, and restroom next to bedroom #2. Rooms that are off-limits need to be made inaccessible during operating hours At 2:05pm, LPA was led on a tour of the property. Tour began in the backyard where there were outdoor toys available for children and a play structure on a grassy area. Per applicant, children will be dropped off in the back yard by parents. There is a outdoor shed present that is off limits and is made inaccessible to children with a lock. Next, LPA inspected the garage converted for activity space. At 2:08pm, LPA observed a room attached to the garage with carpeting, age appropriate toys, and a Air Conditioning (AC) unit on the wall. REPORT CONTINUES PAGE 1 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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 5

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HARRIS FAMILY CHILD CARE	FACILITY NUMBER: 198020847
	VISIT DATE: 08/30/2021

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The converted garage has childrens toys and equipment. AC unit also present in the garage. Photos were obtained of garage play space. Per applicant, the converted garage will only be used for play space and not used for nap or meal time. Declaration obtained. Per applicant, the parent board will be placed in the garage. LPA requested a picture of the postings be submitted to Department. Behind the garage is an outdoor space that will be off limits and is made inaccessible to children. At 2:10pm, tour continued into the back part of the house in the laundry room. Detergents are being kept in an off limits part of the home. At 2:11pm, LPA observed a 2A-10BC Fire extinguisher that did not have a service tag or receipt with date of purchase. Per applicant, they will be purchasing one today and will submit proof to LPA. Tour continued into the restroom adjacent to the laundry room which will be for children's use. There is a door that leads to Bedroom #3 which will be used as an activity space and a nap room for children. LPA inspected the rest of them home which has been identified on the facility sketch as off limits. At 2:13pm, LPA observed a fire place in the living room. Living room has been made inaccessible to children by use of child safety doorknob covers. Last, at 2:18pm, the front yard was inspected. The front yard is completely fenced. There is garden space present and a small sandbox for children to use. Applicant has a wooden cover over the sandbox when not in use. LPA recommended applicant check both the front and backyards each morning for safety, prior to children arriving.

Per applicant, there are no firearms, and weapons on the premises. Applicant states they have a small dog. Dog will be accessible to children in care. There are toys available for children. Applicant also tested the combination smoke and carbon monoxide detectors in the room attached to the garage and the laundry room of house. Both sounded off the alarms and heard by LPA to be functional.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 05/21/17), Pediatric First Aid and CPR (ex. 01/2022). There are emergency supplies in the laundry room and a first aid kit present.

The following was discussed with the applicant:
-Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
REPORT CONTINUES PAGE 2 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HARRIS FAMILY CHILD CARE	FACILITY NUMBER: 198020847
	VISIT DATE: 08/30/2021

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-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility.
--All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Infant Care: Applicant states that she can care for infants. LPA advised the applicant to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The applicant states that she will not sleep infants in a separate room. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided. REPORT CONTINUES PAGE 3 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HARRIS FAMILY CHILD CARE	FACILITY NUMBER: 198020847
	VISIT DATE: 08/30/2021

NARRATIVE

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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

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this application review. The applicant was advised that email may be public information.

During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment. Applicant has completed a Tele-inspection on 10/05/2020 at her previous facility, regarding COVID-19 health and safety protocols.

Per applicant, she does carry liability insurance or a bond in accordance with standard established by Family Child Care statue. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

The applicant does have proof of immunization against influenza, pertussis, and measles.
Applicant completed required mandated reporter training on 07/20/2021. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

LPA consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Patent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection.

REPORT CONTINUES PAGE 4 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HARRIS FAMILY CHILD CARE	FACILITY NUMBER: 198020847
	VISIT DATE: 08/30/2021

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LPA advised the applicant how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:
CHILDREN FORMS/RECORDS , FACILITY FORMS/RECORDS , INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME

The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 09/01/2021.

1. Applicant will purchase a new fire extinguisher and provide proof of purchase
2. Applicant will submit a picture of the parent board when posted.

A small family child care license will be granted upon receipt of proof of corrections for the above and following final application review. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Exit interview was conducted with Lily Harris, Applicant, at 3:35pm who is in agreement with the above.

REPORT ENDS PAGE 5 of 5

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

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