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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405275
Report Date: 01/18/2024
Date Signed: 01/18/2024 02:00:21 PM

Document Has Been Signed on 01/18/2024 02:00 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHALOM FAMILY CHILD CAREFACILITY NUMBER:
197405275
ADMINISTRATOR:MARY SHALOMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 729-0526
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY: 12TOTAL ENROLLED CHILDREN: 13CENSUS: 12DATE:
01/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:MARY SHALOM, LICENSEETIME COMPLETED:
02:15 PM
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On 01/18/2024, Licensing Program Analyst (LPA) Lisa Clayton made an unannounced visit to the Shalom Family Child Care Home to conduct the Required 3-year Inspection. LPA was greeted by Licensee Mary Shalom. LPA Clayton observed 3 infants and 9 toddlers in care, being supervised and cared for appropriately by licensee and 3 fingerprint cleared staff. Hours of operation are Monday through Friday, 8:00am – 5:00pm. Licensee provides breakfast, lunch, snacks and water.

LPA Clayton toured the home inside and outside for a Health and Safety inspection. The home is neat and clean with heating and ventilation for safety and comfort.

LPA confirmed that the single-family home consists of living room, kitchen/dining room, 2 bedrooms, 2 bathrooms, fenced backyard and a detached converted garage which includes a laundry room and a guest bedroom.

The ON LIMIT AREAS are as follows: living room (napping area), kitchen/dining room, bathroom #1, bathroom #2, detached converted garage (main day care area) and fenced back yard.

The OFF-LIMIT AREAS are as follows: bedroom #1, bedroom #2, detached laundry room and detached guest bedroom, all of which are inaccessible to children in care by closed and/or locked doors and visual supervision.

LPA Clayton observed a fully charged 3A:40B:C Fire Extinguisher a working smoke detector, and a working carbon monoxide detector in the main daycare area (converted garage), a working carbon monoxide/smoke detector combo in the hallway of the home, and a fully charged 2A:10B:C Fire Extinguisher in the kitchen.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHALOM FAMILY CHILD CARE
FACILITY NUMBER: 197405275
VISIT DATE: 01/18/2024
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There are no firearms or ammunition on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible to children in care.

There are no pools, ponds or other bodies of water on the premises.

LPA observed age-appropriate toys, books and furnishings. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts.

LPA reviewed 5 children’s files and observed them to be in compliance as they contained current contact information for authorized representatives and/or relatives who can assume responsibility for the child, and authorization for medical treatment, signed Parent’s Rights.


LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.


Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. 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: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHALOM FAMILY CHILD CARE
FACILITY NUMBER: 197405275
VISIT DATE: 01/18/2024
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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 Mary confirmed that there are no Registered Sex Offenders living in the home and LPA completed the RSO profile in FAS.

Licensee is to submit to the Department physical copies of staff immunizations records and updated Mandated Reporter Training certificates immediately upon receipt.

No deficiencies were cited today, per Title 22 Regulations and Health and Safety Codes.

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

LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

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

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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