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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401165
Report Date: 06/07/2024
Date Signed: 06/07/2024 02:21:03 PM

Document Has Been Signed on 06/07/2024 02:21 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WASHINGTON FAMILY DAY CAREFACILITY NUMBER:
197401165
ADMINISTRATOR/
DIRECTOR:
ANN WASHINGTONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 884-9497
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 10TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
06/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Licensee Ann WashingtonTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On June 7, 2024 at 12:45 pm, Licensing Program Analyst (LPA) Angelica Wallin, conducted an unannounced Annual Required Inspection and was met by Licensee, Ann Washington. Hours of operation are from Sunday to Saturday from 6:00 AM to 6:00 PM. LPA toured the home inside and outside and a census was taken.

This is a one-story home which consists of two bedrooms and one bathroom. Areas accessible to children in care include: living room, one bedroom as napping area and isolation area, bathroom, kitchen and front yard. Per Licensee, areas off limits include: one bedroom and backyard. There are six children and one staff present during inspection. Per licensee, seven children enrolled at this time.

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA noted space with age-appropriate toys. There is a working smoke and carbon monoxide detector. During inspection, LPA observed wall heater in living room with a metal barricade. During inspection, LPA observed fire extinguisher with service tag dated 3/2024. Per licensee, cleaning supplies and chemicals located in storage outside. During inspection, LPA observed cleaning supplies and chemicals inaccessible to children in care. LPA observed knives located in kitchen on high shelf inaccessible to children in care. During inspection, LPA observed main bathroom. During inspection, LPA observed container of AJAX bleach on floor under the bathroom sink accessible to children in care. Licensee immediately addressed issue by removing bleach container and placing in an inaccessible to children in care area. According to the applicant, there are no weapons or firearms at the home; LPA did not observe any firearms or weapons at the time of the inspection.

Per licensee, outdoor play is conducted in the front yard. LPA observed facility front yard is fenced. LPA observed no hazards accessible to children in care. LPA advised licensee that total supervision to be maintained at all times during outdoor play when outdoor play is conducted.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON FAMILY DAY CARE
FACILITY NUMBER: 197401165
VISIT DATE: 06/07/2024
NARRATIVE
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LPA observed there no swimming pool or bodies of water. Per licensee, food service and transportation is provided. LPA advised total supervision and safety to be maintained when providing transportation services. Per licensee, overnight care not provided at this time.

During inspection, LPA reviewed five children’s file. LPA observed children’s file updated and maintained. A review of staff records indicates that licensee has the following updated certificates: mandated reporter certificates with expiration date of 10/2024 for licensee and updated immunization records on file for measles, pertussis, influenza and TB clearance. During staff record review, LPA observed licensee and staff CPR/1st aid cards with expiration date of 4/2024. A type B citation issued. During staff record review, LPA observed mandated reporter certificate for one staff with expiration date of 4/2024. A technical violation citation issued. LPA reviewed the following documentation to be kept in facility: facility license, LIC610A, facility fire drill logs, PUB 394, and LIC9040.

Licensee Washington was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation. LPA reviewed with Licensee Washington items prohibited in FCCH, no baby bouncers, no infant walkers, No Johnny jumpers, no saucer chairs, and any other item that falls into that category are not permitted in the facility.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
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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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON FAMILY DAY CARE
FACILITY NUMBER: 197401165
VISIT DATE: 06/07/2024
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This facility does not provides Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Exit interview conducted and report was reviewed with licensee, Ann Washington. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/07/2024 02:21 PM - It Cannot Be Edited


Created By: Angelica Wallin On 06/07/2024 at 01:53 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: WASHINGTON FAMILY DAY CARE

FACILITY NUMBER: 197401165

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in licensee and staff CPR/1st aid cards with expiration date of 4/2024 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2024
Plan of Correction
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Per licensee, updated CPR/1st aid cards to be obtained and picture proof to be submited via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Chambers
LICENSING EVALUATOR NAME:Angelica Wallin
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


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