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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609378
Report Date: 08/29/2022
Date Signed: 08/29/2022 05:27:24 PM

Document Has Been Signed on 08/29/2022 05:27 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:WHITE FAMILY DAY CAREFACILITY NUMBER:
191609378
ADMINISTRATOR:WHITE, GLORIA I.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 604-1010
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 12TOTAL ENROLLED CHILDREN: 18CENSUS: 1DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Tynita White, Licensee AssistantTIME COMPLETED:
05:47 PM
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Licensing Program Analyst (LPA) Susann Sanchez, conducted an unannounced annual required inspection at the above facility on 08/29/2022 at 12:30 PM. LPA met with Damani White, Licensee grandson who was present and caring for one infant. At 12:50pm Tynita White, Assistant/daughter arrived and guided LPA on a tour of the facility including "off limit" area. Assistant informed LPA that a Licensee is present at the facility but is unable to assist LPA at the moment. During tour LPA saw Licensee Gloria White and LPA introduced herself.

This is a two story home which consists of 5 bedrooms, 3 bathrooms, kitchen, dining room, living room , garage and backyard (fenced). The children use a large family room, one bedroom downstairs, backyard and bathroom for daycare. The children's daycare room contains latching wrought iron gates that make every other area in the home inaccessible to children. Per licensee, areas off limits to children and parents include: kitchen, dining room, living room, all upstairs and licensee's other bathrooms.

At 12:35pm LPA observed that there is an above-ground pool which is accessible to children in care (pictures were taken). Per Licensee assistant, the pool was placed for summer time play and swim lessons are provided. The pool is accessible via the sliding glass doors in the family room. There is no alarm on the sliding doors or a lock to prevent a child from accessing the pool. There is no cover on the pool. In addition there is a ladder placed which enhances the accessibility and hazardous risk of a child accessing the body of water. This poses an immediate health and safety risk to children in care. A $500 civil penalty is being assessed during today's inspection. LPA informed Licensee assistant that the pool needs to be removed and discussed water safety and hazards. At this moment Licensee assistant decide they will not use the backyard and will still remove the pool.

At 12:50pm, LPA informed Assistant T. White that Damani White does is not fingerprint cleared. White stated that he lives in the home and has always lived at the facility. White turned 18 in 2018.

At 2:10, LPA left the facility while Licensee assistant picked up school age children (4) from school.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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: WHITE FAMILY DAY CARE
FACILITY NUMBER: 191609378
VISIT DATE: 08/29/2022
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At 5:00, LPA reviewed and provided the PIN 20-24, a sample of an Infant Sleeping Log, and LIC 9227 Individual Infant Sleeping Plan.

Consult was provided for the following:
  • bodies of water
  • fingerprints
  • role of the licensee
  • pets
  • staff files and forms

Due to time constraints and unavailable documents, LPA will return at a later date to complete annual inspection and issue Type B citations that were observed in areas evaluated today.

Based on the LPA’s observations, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were given in Spanish and was explained. Exit interview conducted and report was reviewed with the assistant Tynita White. Also present during the exit interview was Licensee Gloria White.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
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Document Has Been Signed on 08/29/2022 05:27 PM - It Cannot Be Edited


Created By: Susann Sanchez On 08/29/2022 at 04:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WHITE FAMILY DAY CARE
FACILITY NUMBER: 191609378

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. This requirement is not met as evidenced by LPA observing an above-ground pool with no cover and accessible via the sliding door from the family room/daycare room. This poses an immediate health and safety risk to persons in care.
POC Due Date: 08/31/2022
Plan of Correction
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Per Licensee assistant, the pool will come down. Pictures will be submitted to LPA via email by POC due date of 08/31/22. Per Licensee assistant, backyard will be off limit until backyard is cleared.
Request Denied
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 out of 1 uncleareed individuals (Damani White) present in the home which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2022
Plan of Correction
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Licensee assistant stated she will have Damani White fingerprinted today and will not allow her be present at the daycare during hours of operation (Monday to Friday 6am to 6pm) until he has obtained a criminal record clearance. Licensee stated she would provide s copy of the completed livescan and will email a copy to LPA 08/31/2022.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022


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