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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400036
Report Date: 07/11/2019
Date Signed: 07/11/2019 11:08:06 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:CALDWELL FAMILY CHILD CAREFACILITY NUMBER:
198400036
ADMINISTRATOR:ERICA L. CALDWELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 614-6026
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:14CENSUS: 1DATE:
07/11/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Erica CaldwellTIME COMPLETED:
11:10 AM
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Licensing Program Analysts (LPAs) Ana Chico and Denise Gibbs conducted a pre-licensing inspection today for the purpose of a change of location. Ms. Caldwell was previously licensed at 429 W 109TH PL. Los Angeles, CA 90061 #198019431. LPAs met with Erica Caldwell , applicant, who guided analysts on a tour of the facility. At the time of the inspection there were no day care children present. Family members residing in the home are 1 adult and 2 minor children. The applicant is requesting a large family child care home license. A fire clearance was granted for the capacity requested. Per Ms. Caldwell, operation hours will be Monday thru Friday, 6:00AM to 9:00 PM.

All areas identified on the facility sketch were inspected. This is a single story home which consists of 3 bedrooms (one used as an office), 2 bathrooms, dining room, laundry room, living room and kitchen.

Per Ms. Caldwell, the children will use the living room, dining room and restroom adjacent to the hallway. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone and landline available), ventilation and heating (wall heater barricade observed in place). Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children were observed to be inaccessible in the areas designated for children. Latches have been installed on kitchen cabinet to prevent access to chemicals or sharp objects. Applicant states that medicines will be stored in her bedroom which is inaccessible via lock. The applicant states that there are no weapons or poisons on the premises. The applicant was advised that any poisons must be locked with a key or combination lock. No bodies of water were observed at the time of inspection.

Based on the Facility Sketch submitted, areas off limits to children and parents are: All bedrooms, master bathroom and bathroom and laundry room. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

REPORT CONTINUES ON NEXT PAGE 1 of 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CALDWELL FAMILY CHILD CARE
FACILITY NUMBER: 198400036
VISIT DATE: 07/11/2019
NARRATIVE
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·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.
· Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
· Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices
· Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home reviewed.

Infant Care: LPA advised applicant to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. LPA provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Ms. Caldwell stated that infants will sleep in the living room in an approved playpen or cot.

Incidental Medical Services (IMS): 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

Pediatric First Aid and CPR, expires 2021. Mandated Reporter training was discussed as well as new immunization requirements for all adults working or volunteering at the day care. Training must be renewed every two years and can be found at: http:/www.mandatedreporterca.com/training /training.htm. Mandated Reporter Certificates was observed to be current (Ex 3/2020).
PAGE 3 of 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CALDWELL FAMILY CHILD CARE
FACILITY NUMBER: 198400036
VISIT DATE: 07/11/2019
NARRATIVE
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OUTDOOR PLAY AREA
The children will use the front yard for outdoor play. Per Ms. Caldwell she will install a padlock when children are using the front yard. Applicant is aware that 100% supervision is required at all times ____________. The valve on the 2A:10-B:C fire extinguisher indicates that it is fully charged as it was serviced June 2019. Smoke and carbon monoxide detectors were tested and are operable. There are age appropriate materials and toys available for children.

The following was discussed:
· 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. Civil Penalties will be assessed if not in compliance. Ms. Caldwell stated that she fully understands that all adults must be fingerprint cleared prior to moving in her home _______________.
· 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 Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license, immunizations and mandated reporter certificate.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
· The fire extinguisher type 2A:10-B:C must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· 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.
· NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO trampolines and any other item that falls into that category are not permitted in the facility.

PAGE 2 of 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CALDWELL FAMILY CHILD CARE
FACILITY NUMBER: 198400036
VISIT DATE: 07/11/2019
NARRATIVE
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Ms. Caldwell was advised during an office meeting held on 7/10/19 that her application for a change of location would be pending. Items pending are as follows:
  • The licensee shall provide a plan on transferring authority when absent from the home.
  • The licensee will provide a transportation plan, including who will provide the transportation, who will provide car seats, schedules and signed transportation agreements from parent(s)
  • The licensee to attend a care and supervision course or class within 30 days. Proof of attendance shall be submitted. Documentation will be provided to the department prior to attending the selected course/class.
  • Licensee's selected assistant will attend a Family Child Care Home live orientation provided by the department.
  • Large mirror located in the living room shall be bolted or removed.
  • Immunization record for Ms Caldwell

In addition, Ms. Caldwell has been advised that her application for a change of location remains under review and that further administrative action could be taken. Ms. Caldwell fully understands that a license has not been issued to operate a family child care at this location. Exit interview conducted with Ms. Caldwell. Appeal rights provided and explained.


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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
Page: 5 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CALDWELL FAMILY CHILD CARE
FACILITY NUMBER: 198400036
VISIT DATE: 07/11/2019
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LPAs advised how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPAs also reviewed Ms. Caldwell's responsibility to report unusual incidents. LPA reviewed the following forms:

CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:

Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224).

FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:

Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9149).

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following:

Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care.
Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

Report Ends 4 of 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5