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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400476
Report Date: 10/22/2021
Date Signed: 10/22/2021 01:27:20 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:FANSHAW FAMILY CHILD CAREFACILITY NUMBER:
198400476
ADMINISTRATOR:FANSHAW, ITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 920-0362
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:14CENSUS: 0DATE:
10/22/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Ita FanshawTIME COMPLETED:
01:40 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
On October 22, 2021 at 10:35 a.m., Licensing Program Analyst (LPA) Elka Chavez conducted an announced inspection. LPA met with applicant, Ita Fanshaw, who guided analyst on a tour of the facility. The applicant is requesting a change of location of a large family child care home license. Per Applicant, child care will be provided at all hours of the day from Monday through Sunday. Applicant understands that care for a child should not exceed 24 hours. Applicant states she wants to care for children from 3 months to 12 years of age.

At 10:35 a.m. all areas identified on the facility sketch were inspected. This is a single-story home which consists of four bedrooms, 2 bathrooms, living room, dining room, kitchen, bonus room, attached garage, utility room, side yard (fenced), front yard and backyard (fenced). LPA observed two stairs leading into the bonus room without a barricade. The home was inspected for safety, comfort, cleanliness, telephone service (landline and cellular), heating and ventilation are central, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed a medicine cabinet inside the pantry. LPA observed a lock in the pantry door making it inaccessible to children in care. Per Applicant the dogs (poodle and husky) will be kept in the side yard (fenced). LPA observed sliding door and door in the kitchen by the pantry. LPA observed stairs in the door leading to the backyard. LPA did not observe a barricade for the stairs. LPA observed the backyard is adequately fenced. LPA did not observe any bodies of water. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. **Rooms that are off-limits need to be made inaccessible during operating hours**


Areas off limits include: Four bedrooms, living room, kitchen, dining room, attached garage, utility room, front yard and side yard (fenced). LPA observed child safety gates preventing access to the kitchen and the living room making the areas inaccessible to children in care.

Areas used by children include: Bonus room, kitchen area in next to the pantry, bathrooms and backyard (fenced).
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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: FANSHAW FAMILY CHILD CARE
FACILITY NUMBER: 198400476
VISIT DATE: 10/22/2021
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 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. There are age appropriate toys and napping equipment on the premises. The required (3A40BC) fire extinguisher was purchased on 9/15/21. LPA observed the extinguisher in the bedroom hallway next to the kitchen. Smoke detectors and carbon monoxide detectors throughout the home are in operable condition. LPA observed the smoke detector in the bonus room and carbon monoxide detector in the kitchen. LPA did not observe First Aid and Emergency Kit. LPA was unable to observe where the weapons are stored during today’s inspection. Per Applicant it is currently stored at her previous home. The Applicant has current Pediatric First Aid and CPR and expires 9/2023. 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.
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.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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: FANSHAW FAMILY CHILD CARE
FACILITY NUMBER: 198400476
VISIT DATE: 10/22/2021
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
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.
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
Safe Sleep: LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Forms to be posted: LIC610A ,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 9108).
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.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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: FANSHAW FAMILY CHILD CARE
FACILITY NUMBER: 198400476
VISIT DATE: 10/22/2021
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) 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

Based on the LPA’s observation, the following corrections need to be corrected prior to obtaining a large family child care license. Corrections are due by 10/27/21.

· Applicant needs to place a barricade making the stairs in the bonus room and side kitchen door inaccessible to children in care.
· Applicant needs to provide proof of First Aid and Emergency Kit.
· Applicant needs to post the required forms.
· Applicant needs to proof of storage of firearms and other weapons are locked in the home.
· Applicant needs to provide proof of MMR/TDAP for Daniel Dobens.

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 conducted and report was reviewed with Ita Fanshaw.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4