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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400006
Report Date: 12/06/2019
Date Signed: 12/06/2019 09:53:11 AM

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:GREEN FAMILY CHILD CAREFACILITY NUMBER:
198400006
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
12/06/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jenae GreenTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced case management inspection for the purpose of inspecting the facility regarding a capacity increase. LPA met with Licensee Janae Green and cleared assistant. The Licensee is requesting to increase to a Large Family Child Care with a capacity of 12-14 children. Adult family members residing in the home are the Licensee and cleared spouse. LPA observed three (3) children (1 infant, 1 school age and 1 preschool) present at the time of inspection (in compliance with license limitations).

All areas identified on the facility sketch were inspected. This is a one story home which consists of three bedrooms, two full bathrooms, living room, kitchen, dining area, front yard, backyard and garage. There is no fireplace. The applicant uses the large back bedroom, back bathroom and backyard for daycare. All other areas of the home are off limit areas and inaccessible by barrier The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Per applicant, there are no dual licenses at this address. LPA observed age appropriate toys and napping equipment for infants.

The outdoor play area is surrounded by a wooden gate and is safe and free of hazards at this time. There is an inaccessible side area where the Licensee's medium sized dog stays during daycare hours. The Licensee's backyard driveway is inaccessible. The Licensee's garage is off limits. Licensee was advised to provide 100% supervision for safety regarding the outdoor play and field trips.

Per Licensee, there are no firearms, weapons, or bodies of water at the facility. Per applicant, there are no dual licenses at this address. Napping equipment for infants is available. All posting requirements were observed to be posted at the time of visit.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
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: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 198400006
VISIT DATE: 12/06/2019
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Note: A qualified assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility. This includes outdoor activity and activity away from the child care facility. The Licensee's CPR expires October 13, 2020.

The licensee was strongly advised to provide 100% supervision for all outdoor play. Note: LPA provided Licensee with a form listing the possible capacity and ratio scenarios approved under Title 22. LPA also reminded Licensee of the following:

1. All adults working with the children, residing in the home or having initial presence in the facility (during operating hours) must be fingerprint cleared.

2. The capacity and ratio requirements for a small family child care home resume when no assistants are present.

3. All medications, cleaners, chemicals and hazardous items (such as knives, sharp objects etc.) must be inaccessible.

4. The following are not allowed in a family child care home: Baby bouncers, saucer chairs, johnny jumpers, baby walkers, car seats, rockers and trampolines as they may be an immediate risk to children in care.

Note: Licensee has an approved October 23, 2019 Fire Clearance (14 children),

Based on LPA observations and inspection, the Licensee is approved for a Large Family Child Care Home as of December 6, 2019. The Licensee must adhere to terms and limitations on the license.

Upon receipt the Licensee shall post the Notice of Site Visit and the Licensing Report. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted with Licensee Green.

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

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
LIC809 (FAS) - (06/04)
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