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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403941
Report Date: 10/12/2022
Date Signed: 12/01/2022 08:55:26 AM

Document Has Been Signed on 12/01/2022 08:55 AM - 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:POLAND FAMILY DAY CAREFACILITY NUMBER:
197403941
ADMINISTRATOR:POLAND, VICTORIA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 841-8467
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 14TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
10/12/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Victoria Poland, LicenseeTIME COMPLETED:
11:30 AM
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An informal office meeting was scheduled virtually via Microsoft Teams on October 12, 2022.

The purpose of the Supervisory Meeting was to inform Licensee Victoria Poland that the Department has serious concerns regarding violations of Personal Rights that occurred at the Family Child Care Home.

The meeting attendees are as follows:


Maureen Neal, Licensing Program Manager
Adrian Risher, Licensing Program Analyst
Victoria Poland, Licensee
Latanya Pittman, friend of licensee

LPM began the meeting with introductions of licensing staff and purpose of meeting.

Maureen Neal, Licensing Program Manager (LPM), discussed the Department's concern associated with the facility's history.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: POLAND FAMILY DAY CARE
FACILITY NUMBER: 197403941
VISIT DATE: 10/12/2022
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-Facility received 2 type “A” Personal Rights citations

-Discipline policy and the use of inappropriate discipline

-Supervision and safe accommodation for children in care

LPA Neal discussed the purpose of the meeting with the licensee and informed that the supervisory meeting is the first discussion with the licensee, however should the provider be cited for additional serious type “A” deficiencies the department will schedule a Non-Compliance Conference (NCC) which could lead to an administrative action of the license. The administrative process was explained to the licensee.

LPM Neal discussed both personal rights complaints to include inappropriate discipline, supervision and safe accommodation for children in care. The plan of corrections were reviewed and discussed. The licensee was given the opportunity to respond to the above concerns that included what her current plans are regarding discipline, supervision and safe accommodation for children in care. LPM Neal explained that licensees are required to ensure compliance and adhere to Title 22 regulations in order to provide a safe environment for children in care and not only when a citation is issued. In addition to Title 22 the licensee was informed that the department is available to answer questions and licensee can utilize the department as a resource in order to maintain compliance.

LPM discussed the departments Technical Support Program (TSP) which is designed to provide training resources and best practice strategies to improve the quality of care being provided. The licensee has agreed to participate in this program.

The following was discussed and shall be submitted:

a. Licensee will submit the completed Family Child Care Home Orientation certificates for herself and assistant on or before 11/12/2022.



b. Licensee will submit an LIC 855 declaration form indicating she and her assistant reviewed and understood the videos on Providers/Personal Rights on or before 11/12/2022.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: POLAND FAMILY DAY CARE
FACILITY NUMBER: 197403941
VISIT DATE: 10/12/2022
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c. Licensee has agreed to take the course on Preventative Health & Safety and submit certificates for herself and assistant by 11/12/2022.

d. Licensee informed the department that any additional courses she locates she will take and submit certificates of attendance to the department.

e. Licensee will be referred to the Department’s Technical Support Program (TSP). This program will provide additional resources/training regarding personal rights violations. The department will submit the form on licensee behalf.

f. The department will provide the link for licensee to sign-up to receive Child Care Quarterly Updates and Provider Information Notices (PINS).

g. Facility will be placed on increased monitoring beginning 12/1/2022.

Licensee must comply with AB 633 as follows: Upon receipt by the licensee, licensee is to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation - this includes facility visits and substantiated complaint investigations; copies of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care in which issues of noncompliance are discussed and/or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license.

Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of children currently enrolled and any newly enrolled child at the facility for the next 12 months.

A copy of the LIC 809 report was provided to the licensee for signature via email. Signature copy will be kept on file.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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