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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191594940
Report Date: 11/16/2022
Date Signed: 11/16/2022 01:51:40 PM

Document Has Been Signed on 11/16/2022 01:51 PM - It Cannot Be Edited

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:COLBERT FAMILY DAY CAREFACILITY NUMBER:
191594940
ADMINISTRATOR:COLBERT, LEE ETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 213-9767
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
11/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Lee Colbert, LicenseeTIME COMPLETED:
02:30 PM
NARRATIVE
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On 11/16/2022 at 1:05 PM, Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced inspection for the above facility for the purpose of a Case Management - Other inspection. LPA met with Licensee, Lee Colbert. Also present at the facility was Licensee's Assistant (A1), who has been working at the facility for two weeks. LPA arrived during nap time with some children napping in Living Room and daycare activity space. LPA observed seven children in care, three of them infants, at time of inspection. LPA observed required postings and reviewed current roster. LPA provided Licensee with the LIC 126 during visit.

LPA confirmed contact information for Licensee including updated email address for Licensee, Lee Colbert.
LPA conducted file reviews for staff and children during visit which was documented on LIC 857.
—CPR Card valid until: 07/14/2023
—Mandated Reporter AB1207 Completed: 05/15/2022

Licensee (or facility representative) was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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.


Report Continues - Page 1 of 2
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
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 2
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: COLBERT FAMILY DAY CARE
FACILITY NUMBER: 191594940
VISIT DATE: 11/16/2022
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The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today, 11/16/2022, but advisories were given.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Lee Colbert.


Report Ends - Page 2 of 2
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC809 (FAS) - (06/04)
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