198400144-1-29-2021-54-CC-ECHZ-BXQT9R-20210129133221

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400144
Report Date: 01/29/2021
Date Signed: 01/29/2021 01:33:26 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:	CHASE FAMILY CHILD CARE		FACILITY NUMBER:	198400144
ADMINISTRATOR:	DESEREE CHASE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 634-5664
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	14	CENSUS: 0	DATE:	01/29/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Deseree Chase		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	This was a pre-licensing inspection conducted by Elka Chavez, Licensing Program Analyst (LPA) due to COVID-19 and precautionary measures. This pre-licensing inspection was conducted with Deseree Chase, applicant via tele-inspection by use of FaceTime. During this tele-inspection the applicant took LPA on a virtual tour of the home. Applicant applied for a large family child care license. Per Applicant, her operating hours will be Monday through Friday from 6:00 a.m. to 6:00 p.m. Applicant states she wants to care for children from 6 to 13 years of age. At 9:00 a.m. all areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two-story home that consists of 3 bedrooms, 4 bathrooms,office, theater room, foyer, den, gym, child care room, kitchen, dining room, laundry room, back yard (fenced) and garage. Per Applicant, the children will use the child care room, living room, dining room, restroom next to the child care room, den, foyer, and backyard (fenced). LPA observed stairs that lead to the balcony in the backyard. Applicant stated that she will purchase a safety gate to prevent access to the off limit area to children in care. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cellphone), ventilation and heating (central). Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant states that there no poisons in the home and understands that if there are any they will be locked with a key or combination lock. LPA observed a shed in the backyard with a safety key lock to prevent access. Based on the Facility Sketch submitted, areas off limits to children and parents are: Second floor, which includes 3 bedrooms, 2 bathrooms, office and theater room. LPA observed a retractable safety gate at the bottom of the stairs. The gym and laundry room located in the first floor are also off limits. LPA did not observe a lock in the gym door. Applicant stated that she will get a lock for the door to prevent access to children in care. LPA observed a child safety gate in the laundry room. LPA also observed safety locks in all

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

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: CHASE FAMILY CHILD CARE	FACILITY NUMBER: 198400144
	VISIT DATE: 01/29/2021

NARRATIVE

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the cabinet drawers inside of the laundry room. Applicant stated that she keeps her dog (a bichon frise) inside of the laundry room. LPA observed a fireplace in the den to be inaccessible to children in care.

LPA observed safety locks in all the kitchen cabinets. LPA observed knives in a locked kitchen cabinet making them inaccessible to children. The required (2A100BC) fire extinguisher was purchased in 2019. Applicant stated that she is going to purchase a new fire extinguisher. Smoke detectors and carbon monoxide detector are in operable condition. LPA observed the smoke detector and carbon detector in the living room. LPA asked the applicant to press and hold the test button on the smoke detector and carbon monoxide detector, LPA heard loud beeping for both. LPA did not observe napping equipment. The applicant stated that she will order new ones because the ones she had she took them to her center. The applicant states that she will provide food for children in care. If food is not provided and food is brought from the children’s homes; containers shall be labeled with child’s name and properly stored or refrigerated. Per Applicant there are no weapons, firearms in the facility. First aid and emergency kits are available in the laundry room. The Applicant has current Pediatric First Aid and CPR. Applicant has proof of immunization against influenza, pertussis, and measles. Applicant has taken the Mandated Reporter Training.

The following was discussed with the applicant:

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. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
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 adult/infant CPR & Pediatric First Aid certification, TB clearance, immunizations, and a valid criminal record clearance associated to the facility license.
A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

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: CHASE FAMILY CHILD CARE	FACILITY NUMBER: 198400144
	VISIT DATE: 01/29/2021

NARRATIVE

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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. Mandated reporter requirements was reviewed and explained.
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, 24/7.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority.

During this visit, the LPA reviewed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) with the applicant. LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov

Forms to be posted: LIC6101A Emergency Disaster Plan, PUB394 Notification of Parents Rights Poster, Facility License

Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse,

Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).

Children’s records requirements: LIC 700 Identification and Emergency Information, LIC 627 Consent For Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children In Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

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.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

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: CHASE FAMILY CHILD CARE	FACILITY NUMBER: 198400144
	VISIT DATE: 01/29/2021

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COVID-19 Technical Assistance was provided on the date of the tele-inspection. Facility was provided with a Self-Assessment Guide, posters, and information on COVID-19. LPA Chavez discussed protocol in place regarding COVID-19. Applicant stated protocol in place is not having parents fully enter the facility and sign-in/out will take place at the front entrance. The child care is big enough to meet the six feet distance. Applicant will evaluate children for any symptoms such as fever, running nose, cough or child's behavior and will inform authorized representative child cannot stay if any symptoms related to COVID-19; or if symptoms appear during the day, applicant will isolate the child and call authorized representative for immediate pick-up. Children will wash their hands during arrival, entering from outdoor play, meal times, covering their cough, and from using the restroom. LPA Chavez did not observe the hand-washing poster in the restroom used by the day care children. Applicant stated that she was in the process of putting the poster up in the bathroom and day care room. LPA observed the posters applicant was going to display. It was stated that the staff is aware of cleaning, disinfecting, sanitizing and the importance of constant hand-washing.

Based on the LPA’s observation, the following correction needs to be corrected prior to obtaining a large family child care license. Corrections are due by 02/05/2021.

· Lock on the door to the off-limit gym
· Safety gate for stairs in the backyard leading to the balcony in the second floor
· Napping equipment
· Fire Extinguisher (2A10BC)
· Posting of Covid-19 Signs

A large family child care license will be granted upon receipt of proof of corrections. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

Exit interview was conducted with Deseree Chase, via tele-inspection, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Applicant via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature. A copy of this report and all other licensing reports must be made available to the public for 3 years.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

LIC809 (FAS) - (06/04)

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