198400006-6-15-2021-54-CC-RDEO-C3ZRTY-20210615131908

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400006
Report Date: 06/15/2021
Date Signed: 06/15/2021 01:19:21 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	GREEN FAMILY CHILD CARE		FACILITY NUMBER:	198400006
ADMINISTRATOR:	JENAE GREEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 713-1163
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	14	CENSUS: 7	DATE:	06/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Licensee - Jenae Green		TIME COMPLETED:	01:30 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 Analysts (LPAs) Randy Derraco and Denise Gibbs conducted an unannounced annual inspection to the above facility on 06/15/2021. LPAs arrived at the facility at 10:30 AM and met with Jenae Green, Licensee who guided analysts on a tour of the facility. Also present during this inspection, was her assistant (A1). Per Licensee, there are 10 children that are currently enrolled. A current children’s roster was available for review. Upon arrival, LPAs observed 4 children in care. At 11:00AM, LPAs observed three additional children being dropped off for care. This is a one-story home which consists of three bedrooms, two bathrooms, kitchen, living room, front yard and backyard (fenced). The main care area is located in the bedroom to the right of the side entrance. The children use the bathroom in the main care area. Per Licensee, areas off limits to children and parents include: two bedrooms, on suite bathroom, living room, kitchen, and garage. The licensee provides food for children in care. Parents enter the facility through the driveway gate, at the side entrance. Individuals who reside in the home were noted and discussed. Per Licensee, they currently have one assistant. All adults present in the home have obtained a criminal record clearance. 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 land line, central ventilation and heating. Age appropriate toys, play equipment and materials were observed in the main care area. Per licensee, detergents, cleaning compounds, and other items which could pose a danger to children are inaccessible in a locked garage. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked The restroom that children use was observed to be safe and sanitary

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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: 06/15/2021

NARRATIVE

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The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 02/08//21, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

Licensee states that infants sleep in the main care area. Appropriate sleeping arrangements and cribs were observed. One playpen for each infant in care was observed. Playpens did not hinder the entrance or exit from the sleeping space. Mattresses in the playpens were observed to have fitted sheets. Playpens were observed to be free of loose articles and objects. LPAs discussed LIC 9227 and infant sleep check documentation. LPA provided the licensee with a copy of PIN 20-24, recently approved safe sleep regulations in effect which includes LIC 9227 Individual Infant sleeping plan.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to have perimeter fencing. LPAs observed age appropriate toys and other materials for children to play with. LPAs did not observe any objects that can pose a danger to children in the outdoor yard.

The licensee is observed to be operating within the license capacity limitations.

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 08/13/2022. First aid supplies were observed in a locked storage shed. LPAs advised that if a child shows signs of illness they shall be separated from other children. Licensee states that entrance area can be used to isolate children showing signs of illness.

Children’s records were reviewed, including emergency information and were observed to be complete. The licensee does have proof of immunization against influenza, pertussis, and measles. LPAs observed that the Licensee and assistant do have proof of the Mandated Reporter AB 1207 compliant.

Licensee has one dog and they are kept behind a locked fenced gate on the side of the house during operating hours.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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: 06/15/2021

NARRATIVE

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LPAs did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family child care facility.

Incidental Medical Services (IMS):

The licensee states that she does not currenlty 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.
LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

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

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. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee Jenae Green, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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