<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400181
Report Date: 02/07/2020
Date Signed: 02/07/2020 12:03:02 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:PATRICK FAMILY CHILD CAREFACILITY NUMBER:
198400181
ADMINISTRATOR:JENNIPHER PATRICKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 354-8735
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY:14CENSUS: 0DATE:
02/07/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jennipher PatrickTIME COMPLETED:
12:15 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 is an announced Pre-licensing Inspection conducted today by Alicia Bailey, Licensing Program Analyst (LPA). Met with applicant/ licensee Patrick who guided analyst on a tour of the facility. This is facility is a relocation previous facility # 198018019. There are no children in care at this time. All areas identified on the facility sketch were inspected. This is a single story, home. Family members residing at the facility are 1 adults and 2 children. The home was inspected for safety, comfort, cleanness, 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 other licenses held at this location Days and Hours of child care: Monday thru Sunday from 6:00am to 5:00am 23 hours.Applicant / licensee states they want to care for children 6 mos-12 y/o.

Applicant owns/rents property shown as proof of renting.

Applicant has completed the Pediatric CPR/First Aid on 01/06/2020 and expires on 01/06/2022 as indicated on the certificates and Preventative Health practices taken on: 01/12/2020. Applicant Licensee Patrick provided licensee assistant CPR/First Aid,Mandated reporter certificate, and immunizations

Areas off limits include: 2 Bedrooms, 1 Bathroom, Kitchen, Laundry room, Garage, Back yard area behind the house. front yard
**Rooms that are off-limits need to be made inaccessible during operating hours**

Areas used by children include: Living room, 1 bedroom, 1 bathroom, back yard side area of the house.









SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 198400181
VISIT DATE: 02/07/2020
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
26
27
28
29
30
31
32
LPA Bailey inspected the areas to be used by the day care children. The Living room and One bedroom will be used for Activity, eating and napping. The napping equipment were observed ,there is a crib available for infants. The children’s restroom was inspected. LPA did not observe any accessible hazards. There are safety latches installed on the sink cabinets and drawers in the bathroom.

LPA Bailey observed in the kitchen there is a knives are kept in a higher level cabinet which is latched. The first aid kit is located kitchen. The required fire extinguisher (2A 10BC), one locate in living room and one in the kitchen. There is a smoke and carbon monoxide combination detector installed in the living room. LPA tested the detector and found it in operable condition.

Per applicant there are no weapons, firearms in the facility currently. Backyard is adequately fenced and there are no swimming pool, spa or other bodies of water observed on the premises. There are age appropriate toys outside and inside premises.

A parent area with required postings was observed at the entrance of the facility.

During the inspection applicant Patrick receive a phone call from the fire inspector from Los Angeles county. The inspector made a visit two days prior regarding the installations of the fire alarm. The inspector was concern about the use of the garage as a play area. The inspector stated he can only approve the garage if the applicant get approval from Los Angeles County building and safety. As for now the applicant stated the garage is off limits. Applicant stated she was inspected by two different fire department.




SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 198400181
VISIT DATE: 02/07/2020
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
26
27
28
29
30
31
32
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, 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 2A-10BC 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.
·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.
·No baby bouncers, 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.
·All adults living and working in the home shall be made of aware of the Departments right to inspection authority.
·Liability insurance was discussed with applicant.
·Mandated reporter training must be taken every 2 years.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
LIC809 (FAS) - (06/04)
Page: 4 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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 198400181
VISIT DATE: 02/07/2020
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
26
27
28
29
30
31
32
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.

Distributed and explained the following sample forms packet:

Children’s Records Requirements:
LIC 9040 Child Care Facility Roster
LIC 700 Identification and Emergency Information
LIC 627 Consent for Emergency Medical Treatment
LIC 282 Affidavit Regarding Liability Insurance
LIC 624 B Unusual Incident/Injury Report
LIC 9150 Parent Notification Additional Children in Care,
Immunization record
PUB 72- Family Child Care Consumer Guide
LIC 995A Notification of Parent’s Rights
LIC 613 A Personal Rights

Recommended Records:
LIC 702 Child’s Preadmission Health History – Parent’s Report
LIC 9108 Statement Acknowledging Requirement to Report Suspected Child Abuse.

Employee records Requirements:
LIC 9052 Employee Rights
LIC 508- Criminal Record Statement
 Test for Tuberculosis. Ensure no active response is detected.
Criminal Clearance; copy of live scan receipt and/or criminal record results.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 198400181
VISIT DATE: 02/07/2020
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
26
27
28
29
30
31
32
The following items must be corrected within thirty (30) days prior to issuance of a license:

1. Removal metal sheets against backyard fence
2. Removal Pesticides on side of the garage in the front yard

Licensure is contingent upon completion of the above corrections.

Exit interview was conducted with applicant . Appeal Rights procedures issues and explained.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia BaileyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5