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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401365
Report Date: 06/13/2023
Date Signed: 06/14/2023 02:36:06 PM

Document Has Been Signed on 06/14/2023 02:36 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:COLEMAN FAMILY DAY CAREFACILITY NUMBER:
197401365
ADMINISTRATOR:COLEMAN, KELLY JOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 296-3229
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 12TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
06/13/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Kelly Coleman, LicenseeTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPA) Shandra Powell conducted an unannounced Annual/Random required inspection at the above facility on 06/13/2023. LPA arrived at the facility, identified self and met with Kelly Coleman, Licensee. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. A Risk Assessment for COVID-19 was completed before entry. LPA toured the home with licensee. LPA observed children in care (3 school age, 3 preschoolers and 1 infant) with 1 Assistant whom has been cleared by Care Provider Management Bureau(CPMB). This is a two story home. Licensee stated 3 adults including herself live in the home. Facility operation hours are Monday thru Sunday 24hrs aday. LPA observed seven children in care with licensee and one assistant. Licensee stated food is provided however families can bring food into facility. LPA reminded licensee that all food brought into facility must be labeled.
LPA toured the inside and outside of the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The home is a two story with five bedrooms, two and a 1/4 bathrooms, kitchen, family room, living room, laundry room and attached garage. Per Licensee, no childcare is conducted in the attached garage. LPA observed garage to be full of house hold items and overflow items such as water their is also an aquarium located in garage which houses insects for feeders for the Turtle and Lizard whom live inside the home. LPA observed the Turtle in aquarium in family room during inspection (child care room). Licensee confirmed that the family room located through the hallway to the rear of the home is the primary childcare area.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: COLEMAN FAMILY DAY CARE
FACILITY NUMBER: 197401365
VISIT DATE: 06/13/2023
NARRATIVE
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 LPA observed children playthings located in family room for children use during inspection.

All bedrooms in the home and the bathroom located upstairs are off-limits and made inaccessible to children in care by use of closed and/or locked doors during operation hours. LPA observed a gate at the bottom stairwell entrance to the second floor of the home. LPA advised licensee to keep garage entry door located in family room locked at all times to make inaccessible to children in care. LPA advised licensee that all off limit bedroom doors located downstairs must be locked. LPA observed a child gate in front of bedroom door #3.

LPA did not observe pool, spa, hot tub or other similar bodies of water on the premise.
Per Licensee, there are no firearms, ammunition or weapons on the premise; none were observed by LPA. Per Licensee no poisons are located on the premise. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.
There is at least one working fire extinguisher, smoke detector and carbon monoxide detector in the home (tested during inspection). Centralized heat and fans are used for cooling source.

The home has working telephone service and LPA confirmed the phone number is on file.

The outdoor play area is conducted at a local park and our walks. LPA advised Licensee, if children are transported to the park to have parent/authorized representative sign an agreement of consent and place in child's physical file. LPA also advised Licensee that a copy of the transporter's driver's license and insurance is to be placed on file at the facility. Licensee ensures that children in care, are supervised at all times and are not left in parked vehicles.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: COLEMAN FAMILY DAY CARE
FACILITY NUMBER: 197401365
VISIT DATE: 06/13/2023
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Licensee completed Mandated Reporter training on 07/04/2022. LPA advised Licensee that Mandated Reporter training is to be renewed every two years and certificate of completion is to be placed in each employee's physical file. LPA observed licensees CPR/First Aid certification expires on 11/2024. However Assistant CPR/First Aid certification expired in 2018. LPA discussed with licensee the reason for assistant to keep CPR/First Aid updated at all times. Failure to renew CPR/First Aid certification, causes a potential health, safety or personal rights risk to children in care.

The following was observed and reviewed during this inspection: LPA reviewed required posted documentation. Facility License, Publication (PUB) 394 and Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster and Drill Log, last drill conducted on in January 2023 per licensee and log review.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights; LPA observed the Individual Infant Sleeping Plan LIC 9227 in file during inspection Whoever LPA did not observe the 15min Log for observation of Infant Sleeping. During inspection licensee created a 15min Log.

Infant Care: Licensee currently cares for infants. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep log check documentation for infants 0-24 months, and provided licensee with a copy of Title 12 Regulation 102425.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: COLEMAN FAMILY DAY CARE
FACILITY NUMBER: 197401365
VISIT DATE: 06/13/2023
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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.

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 [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.

The licensee is also reminded that Baby walkers, bouncers and similar items are not allowed in child care facilities.



LPA observed a completed First Aid Kit at facility during inspection. Licensee stated the isolation area for ill children is located in the living room of the home.
All medication is kept in a locked cabinet in the kitchen area. LPA observed all kitchen cabinets to have child safety latches during inspection.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: COLEMAN FAMILY DAY CARE
FACILITY NUMBER: 197401365
VISIT DATE: 06/13/2023
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LPA provided the licensee with The Department of Social Services - Community Care Licensing Division website: http://www.ccld.ca.gov


A notice of site visit and appeal rights were given Notice of Site Visit must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee, Kelly Coleman.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/14/2023 02:36 PM - It Cannot Be Edited


Created By: Shandra Powell On 06/13/2023 at 12:09 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: COLEMAN FAMILY DAY CARE
FACILITY NUMBER: 197401365

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2023

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2023
Plan of Correction
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Licensee stated Assistant will complete CPR/First Aid training by POC date of 06/19/2023 and a copy shall be emailed to LPA on or before POC date.
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:Karren Starks
LICENSING EVALUATOR NAME:Shandra Powell
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023


LIC809 (FAS) - (06/04)
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