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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609378
Report Date: 09/22/2022
Date Signed: 09/22/2022 02:39:57 PM

Document Has Been Signed on 09/22/2022 02:39 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: 12CENSUS: 1DATE:
09/22/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tynita White, Licensee AssistantTIME COMPLETED:
03:05 PM
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On 09/22/2022 at 12:00 pm, Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced annual – continuation from 08/29/2022 inspection at the above facility. LPA met with Damani Whitewalker, assistant who guided analyst on a tour of the facility. A fingerprinted family member was also present during inspection. There was 1 infant present during inspection. Facility capacity is in compliance for a large Family Child Care Home.

This is a two story home which consists of 5 bedrooms, 3 bathrooms, kitchen, dining room, living room, family 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 12:30pm, Licensee Gloria White and Licensee assistant Tynita White.

Consult was given at this time until 1:40, regarding visit from 08/29/2022 and about adding Damani Whitwalker & Tynita White to the licensee as co-licensee. Forms were provided to update facility file.

The hours of operation are Monday to Friday from 6:00 AM to 6:00PM. Meals and snacks are provided by the Licensee. Licensee was reminded that children who bring food from home must be labeled with the child’s name and properly stored or refrigerated.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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: 09/22/2022
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LPA observed the following documents posted Facility License, Notification of Parents' Rights (PUB 394), Earthquake Preparedness (LIC 9148), Emergency Disaster Plan (LIC 610A), and Facility Roster (LIC 9040). Disaster and Fire Drill was last conducted on 08/26/2022.

Smoke and carbon monoxide detectors were tested and are operable. LPA observe a fire extinguisher in the family room and was purchased on 09/12/22. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA's observed that detergents, cleaning compounds and medication are stored in the in the garage, inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be locked and inaccessible to children. Isolation area for sick children waiting to be picked up is in the bedroom, away from the other children. Per Licensee there are no firearms or weapons present in the home.

Currently, children are using the backyard for outdoor play. The outdoor play area was observed to be fenced. . LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.

Infant Care: Currently licensee has 1 infant enroll and 1 infant was present during inspection. LPA observed 1 crib located in the family room. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the crib. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP on 08/29/22. Licensee states the following a sleep supervision plan for infants: to continue sleeping children in the family room. Safe sleep, Infant sleeping plan, and 15-minute log was also discussed on 08/29/2022. LPA observed the sleep log and observed assistant checking infant every 15 minutes.

Children’s records were reviewed for Affidavit Regarding Liability Insurance (LIC 282), Immunization Records, Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), and Notification of Parents’ Rights (LIC 995A). LPA conducted a personnel record review for the following documents: Criminal Record Statement (LIC 508), Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Pediatric CPR/First Aid (expires: 02/2023), TB clearance and proof of immunization records for measles (MMR), pertussis (Tdap), and Influenza. Mandated Reporter is current and will expire on 09/07/24.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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: 09/22/2022
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There are three small dogs in the home.

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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee 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

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.



LPA discussed the safe sleep regulations with licensee 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 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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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: 09/22/2022
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During inspection LPA cleared citations cited on 08/29/22.

Based on the LPA's observations and records review no deficiencies will be cited today 9/22/22.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and explained. Exit interview conducted and report was reviewed with the Licensee assistant White. Licensee Gloria White was also present during exit interview.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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