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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020847
Report Date: 05/06/2022
Date Signed: 05/06/2022 11:16:17 AM


Document Has Been Signed on 05/06/2022 11:16 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:HARRIS FAMILY CHILD CAREFACILITY NUMBER:
198020847
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
05/06/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Lily Harris - LicenseeTIME COMPLETED:
11:23 AM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management-Licensee Initiated inspection, to the above facility. This inspection is being conducted for a requested capacity increase. The facility is requesting to increase from a small family child care with a capacity of 8, to a large family child care with a capacity of 14. At 8:55am LPA met with licensee, Lily Harris. Also present during this inspection, is Licensee’s assistant. The licensee states that she currently has 8 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 8:30am-3:30pm, Monday-Friday.

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. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 2 adults and 2 children currently live in the home. Person who live in the home were identified on the attached LIC811. Licensee states that she currently has one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT


At 09:05am LPA was lead on a tour of the facility by the licensee. The tour began in the front yard where the children are dropped off. There is a grass portion with a play structure and a garden used for activities with the children. The driveway leads down to the backyard and is also used as a bike path for children. The facility has tables and chairs in the back yard for activities and for meal time. The converted garage keeps its door open and has age appropriate toys and equipment for children in care. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted on the wall of the converted garage. REPORT CONTINUE PAGE 1 of 4
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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 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: 05/06/2022
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There is a back door to the garage that leads to a woodchip section that has sensory bins and additional equipment for child activities. There is a side room attached to the garage that is used as child activity space. There are numerous books and equipment for children in care to use. Next to the garage is an additional grass area with a slide for children in care to play on. LPA was led into the main house through the back door, which leads directly to the laundry room. In the laundry room, LPA observed first aid supplies available and smoke and carbon monoxide detectors were tested and are operable. At 9:15am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 08/30/2021, as indicated on the receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Next, LPA reviewed the bathroom connected to the laundry room. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. On the other side of the bathroom, there is a door that leads to a bedroom used for nap time. LPA observed the storage of thick mats for children to utilize during nap time. Per licensee, an outside shaded area will be used as an area for an ill child until an authorized representative comes to pick up child. The licensee states that a cell phone is used and stays at the facility during operating hours. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 04/2024. Licensee has complete mandated reporter training that expires on 07/20/2023. During review of Licensee's assistant's staff file, LPA observed that their Mandated Reporter Child Care Provider (AB1207) Training expired 02/01/2021. LPA discussed the importance of keeping the mandated reporter training current while working with children. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

REPORT CONTINUES PAGE 2 of 4

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
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: 05/06/2022
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The following was discussed:
-There are one pet on the premises. Licensee has a small dog that is accessible to the children in care
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.
-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.

Infant Care: Licensee states that they are currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep on mats in the nap room. LPA discussed with the licensee the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):


The licensee states that she will provide IMS. 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.

At this time, licensee is not in compliance with Title 22 regulations. Upon receipt of corrections, licensee will be granted a license for a Large Family Child Care Home, pending final review.

Based on the LPA’s observations and records review, the following deficiencies 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



REPORT CONTINUES PAGE 3 of 4
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
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: 05/06/2022
NARRATIVE
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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.
Exit interview was conducted with Licensee Lily Harris, at 11:03am and Plan of Corrections were reviewed and developed. A copy of the report was provided.

END OF REPORT PAGE 4 of 4
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 05/06/2022 11:16 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: HARRIS FAMILY CHILD CARE
FACILITY NUMBER: 198020847

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2022
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years
This requirement was not met as evidenced by:
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Based on record review, Licensee did not ensure that their assistant had renewed their Mandated Reporter Child Care Provider (AB1207) Training, as the certificate on file indicates 02/01/2021 as the expiration date. This poses a potential risk to the health, safety, and personal rights of children 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5