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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400036
Report Date: 06/16/2021
Date Signed: 06/16/2021 12:31:30 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: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:
06/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Erica Caldwell, LicenseeTIME COMPLETED:
12:30 PM
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On June 16, 2021 at 10:25am Licensing Program Analysts Alicia Mooberry conducted an unannounced site inspection to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPA met with Licensee, Erica Caldwell and toured the facility. There was 1 child present at the time of the inspection.

The facility is a one story, 3-Bed, 2-Bath home. Per Licensee the following areas are used for day-care are the living room (main day care area), restroom, dining room, kitchen, front yard. Per Licensee, off limit areas include: All (3) bedrooms, 1 bath, laundry room and backyard. Per licensee, operating hours are from 6:30 AM - 6:00 PM, Monday - Friday. Off limit areas are kept inaccessible by locked doors.

Licensee has the Parent’s Rights poster and other appropriate forms posted on wall in the living room. LPA observe a disaster drill log. Licensee was reminded to conduct disaster drills every six months. Licensee has a working home telephone.

Detergents and cleaning supplies were kept in locked cabinets in the kitchen under the sink and in the laundry room. Fire extinguisher indicated fully charged however the last date of service was on 6/21/19. LPA observed a wall heater that is barricaded.

There is an operational smoke detector and carbon monoxide in the living room. The home has electrical outlet covers throughout and maintains a First Aid Kit. There are adequate age appropriate toys, books, and games.

There are no firearms present on the premises as stated by licensee. LPA inspected the gated front yard which is used as play area, there are appropriate toys and no hazards were observed. There are no pools or spas, or other bodies of water. Currently there are no pets.


Report continues on 809C
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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 4
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: 06/16/2021
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Licensee's Pediatric First Aid and CPR certificate is valid until 06/17/21. Per Licensee will enroll in EMSA approved CPR/1st Aid course. Children's Roster was observed to be updated and available. Child’s file was reviewed and found complete.
LPA observed napping equipment including play yard for infants to nap in.

The following were discussed: 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. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting. Unusual incidents are to be reported to Licensing Office within 24 hours.

· 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

· Infant Care: Licensee is currently providing care for infants. LPA advised licensee to sleep infants where they can be directly supervised at all times. Infants sleep in living room/main child care area. 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. During this inspection a copy of the Recently Approved Safe Sleep Regulation PIN 20-24-CCP was provided. Licensee was advised to keep sleeping log and check on infants every 15 minutes.

COVID-19: Licensee was advise to go to CDSS.ca.gov for the most up to date guidelines for COVID. As of 6/15/21 children over the age of 2 years old are required to wear a face covering and follow social Distancing guidelines in the childcare setting. LPA observed COVID-19 postings, hand sanitizer and sanitizing products in the home.
Report continues on 809C
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 06/16/2021
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Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D.

LPA advised the Licensee to access forms and regulations on line at: www.cdss.ca.gov
Email Address: on file

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit 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, Erica Caldwell. Appeal rights discussed and explained.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2021
Section Cited

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Operation of a Family Child Care Home- The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.

This requirement was not met as evidenced by:
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LPA observed the 2A10BC Fire Extringusher with Service date 6/21/19. Per Licensee the Fire extinguisher was purchased over a year ago and has not been serviced. This is a potential risK to the health and safety of children in 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4