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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006756
Report Date: 12/16/2024
Date Signed: 12/16/2024 12:20:08 PM

Document Has Been Signed on 12/16/2024 12:20 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GUILLAUME FAMILY CHILD CAREFACILITY NUMBER:
192006756
ADMINISTRATOR/
DIRECTOR:		GUILLAUME, MARIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 709-3062
CITY:LOS ANGELESSTATE: CAZIP CODE:
90016
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
12/16/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:MARIE & JEAN GUILLAUME, LICENSEESTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 12/16/2024, Licensing Program Analyst (LPA) Lisa Clayton made an unannounced visit to the Guillaume Family Child Care Home to conduct the Required 3-year inspection. LPA was greeted by Licensee Marie and Jean Guillaume. There were no children in care. Per Licensees the hours of operation are Monday through Friday 6am – 12am. Licensee provides snacks, milk and water.

LPA toured the entire home inside and outside for a Health and Safety inspection. The home is neat and clean and has ventilation for safety and comfort. The home has working telephone and LPA Clayton confirmed the number is (213) 709 - 3062.

LPA Clayton confirmed that the single-family home consists of the following: living room, dining room, kitchen, 2 bedrooms, 1 bathroom, family room, attached storage room, fenced front yard and fenced back yard.

The ON LIMIT AREAS are as follows: family room (day care activity room), bathroom and the fenced backyard. The ISOLATION AREA will be in the day care activity room.

The OFF-LIMIT AREAS are as follows: the kitchen, living room, dining room, bedroom #1, bedroom #2 and the storage room, all of which are inaccessible to children in care by child safety gates and/or closed and/or locked doors and visual supervision.

Furniture and equipment are in good condition and free of sharp, loose, or pointed parts. There are no pools, ponds or any other bodies of water on the premises. There are no firearms or ammunition on the property.



The home has a fully charged 2A10BC fire extinguisher, a working carbon monoxide detector and working smoke detector in the day care activity room.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GUILLAUME FAMILY CHILD CARE
FACILITY NUMBER: 192006756
VISIT DATE: 12/16/2024
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LPA Clayton reviewed 5 children’s files which contain current contact information for authorized representatives and/or relatives who can assume responsibility for the child, and signed Parent’s Rights. LPA Clayton instructed the Licensee to have the parents provide current immunization records, and proof of enrollment in school, and a signed Consent for Emergency Medical Treatment form for children enrolled.

Licensee have current CPR/First Aid certificate that expires April 2025. Licensees have immunizations records and are in compliance with immunizations required for childcare providers.

Licensee Marie stated that the FCCH does not provide care to children under 3 years of age. LPA Clayton reminded license to check the Safe Sleep webpage on the Child Care website https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and­resources/safesleep as an additional resource.

LPA Clayton informed applicant of the importance of checking for recalled infant devices on the United States Consumer Products 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 the purchased equipment.


Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office upon completion. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA reminded Licensee of the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GUILLAUME FAMILY CHILD CARE
FACILITY NUMBER: 192006756
VISIT DATE: 12/16/2024
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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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&R) throughout California.


During the exit interview, Licensee Marie confirmed that there are no Registered Sex Offenders living in the home and LPA completed the RSO profile in FAS.

Per Title 22 Regulations and Health and Safety Codes, Technical Violations were cited today (see LIC 9102).

Licensee were given the information to take the Mandated Reporter Training course and are to submit the certificates of completion to the Department no later than January 2, 2025.

An exit interview was conducted, a copy of this report was read and provided to licensee and will be made available to the public upon request.

LPA Clayton posted a Notice of Site Visit which is required to be posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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