198400286-10-1-2020-54-CC-MAYA-BTYTDE-20201001143814

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400286
Report Date: 09/28/2020
Date Signed: 10/01/2020 02:38:46 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:	MOORE FAMILY CHILD CARE		FACILITY NUMBER:	198400286
ADMINISTRATOR:	CHRYSTAL MOORE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 362-9727
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	14	CENSUS: 0	DATE:	09/28/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Applicant, Chrystal Moore		TIME COMPLETED:	11:15 AM

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	On September 28, 2020 at 10:00 AM, Licensing Program Analyst (LPA) Monique Ayala conducted an announced Pre-licensing tele-inspection via Zoom Meeting with Applicant, Chrystal Moore. The purpose of the tele-inspection was to conduct the Pre-licensing inspection for the pending Change of Location and Capacity Change application. The inspection was conducted via Zoom Meeting due to the Coronavirus Disease 2019 (COVID-19) pandemic. The applicant is requesting a Capacity Change from a Small Home (up to 8 children) to a Large Home (up to 14 children). The Department received a granted Fire Clearance for the capacity change. The applicant resides in the home with one other adult and two minor children. The operating hours will be Sunday to Saturday from 6:00 AM to 6:00 PM. The applicant is applying to care for children ages, newborn to 5 years old. All areas identified on the facility sketch were virtually inspected. This facility is a single family home that consists of three (3) bedrooms, one (1) bathroom, living room, laundry room, kitchen, garage and two back yard areas (fenced). The detached garage is converted into a living space that consists of two (2) rooms, 1 bathroom, a kitchen and enclosed patio. Areas that are accessible to children include: living room, 2 kitchens, 2 bathrooms, 1 room (located inside detached garage) and the fenced back yard between the home and detached garage. Per applicant, the children will utilize the fenced yard between the home and garage for outdoor activity. Areas off limits to children include: 3 bedrooms, laundry room, one room (located inside garage), front yard, enclosed patio (attached to garage) and the fenced back yard behind the garage. LPA observed safety gates installed making the off-limit areas inaccessible to children. The applicant was advised that off-limits areas must be made inaccessible during operating hours.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2020

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198400286
	VISIT DATE: 09/28/2020

NARRATIVE

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Areas used by the children were inspected for safety, comfort, cleanliness and telephone service. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. Applicant stated that there are no poisons in the home. The applicant was advised that if any poisons are purchased, it is required to be locked with a key or combination lock. The applicant was also advised that if food is brought from the children’s home, all containers must be labeled with the child’s name and properly stored or refrigerated.

Per applicant, there are no pets, firearms, weapons or bodies of water on the premises. LPA observed age appropriate toys and napping equipment for the children. LPA observed the required fire extinguisher (2A-10BC) that is fully charged. Smoke and carbon monoxide detectors were tested by applicant and are operable. A First Aid kit is available with a thermometer and is located in the bathroom (located inside the home) and kitchen (located inside the garage).

The applicant has proof of Pediatric First Aid/CPR (expires: 02/2022). The applicant has proof of immunization against pertussis and measles. The applicant completed the Preventative Health and Safety Training, including Nutrition on 12/17/2017, Lead Poisoning Prevention Training on 09/18/2020 and Mandated Reporter Training (AB 1207) on 09/19/2020. Applicant was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

During the tele-inspection, LPA discussed Forms/Records to Keep in Your Family Child Care Home (LIC 311D). LPA also discussed reference material on the California Car Seat Law Changes (effective January 1, 2017), Effects of Lead Exposure, Shaken Baby Syndrome, Sudden Infant Death Syndrome (SIDS), the approved safe sleep regulations in effect (Provider Information Notice (PIN) 20-22-CCP, dated 09/15/2020), and COVID-19 updated guidance for child care setting (PIN 20-15-CCP, dated 07/15/2020).

LPA observed the following forms posted in the facility: Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148) and Notification of Parents’ Rights Poster (PUB 394).

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2020

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198400286
	VISIT DATE: 09/28/2020

NARRATIVE

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Facility Forms/Records to keep in your home:
1. Personnel Records as required in Title 22, Division 12, Chapter 3, Section 102416.1, including but not limited to, proof of current pediatric first aid, CPR, preventative health practices certificate, mandated reporter training certificate and criminal record information.
2. Unusual Incident/Injury Report (LIC 624B).
3. Child Care Facility Roster (LIC 9040).
4. Notice of Employee Rights (LIC 9052).
5. Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108).
6. Property Owner/Landlord Consent Form (LIC 9149).
7. Property Owner/Landlord Notification Form (LIC 9151).
8. A copy of your deed or lease/rental agreement.

The following was also discussed with the Licensee:
1. Individuals who are 18 years of age or older and 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 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.
2. 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 and Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
3. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.
4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.
5. 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.
6. 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.
7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2020

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198400286
	VISIT DATE: 09/28/2020

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8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.
9. Smoking is prohibited in the family child care home.
10. Children and staff records must be maintained and updated as needed and be available for review by the Department.
11. Dog(s) and/or pets are recommended to be isolated from children in care.
12. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category is not permitted in the facility.

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 Americans with Disabilities Act (ADA) was provided: U.S. 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 applicant on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at www.ccld.ca.gov.

A final review of the pending application for a Change of Location and Capacity Change will be conducted by the Department. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

An exit interview was conducted and a copy of this report was issued to the applicant via registered mail and certified mail. The applicant stated that she will submit the original signed copy of this report to the Monterey Park South West Child Care Regional Office.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2020

LIC809 (FAS) - (06/04)

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