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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405743
Report Date: 03/15/2024
Date Signed: 03/15/2024 11:46:52 AM

Document Has Been Signed on 03/15/2024 11:46 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:PERGES AND LEAVELL FAMILY CHILD CAREFACILITY NUMBER:
197405743
ADMINISTRATOR:PERGES, S. AND C. LEAVELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 918-3725
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
03/15/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Co-licensee Shanae Pergess and Carlean LeavellTIME COMPLETED:
12:05 PM
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On March 15, 2024 at 9:30 am, Licensing Program Analysts (LPA) Angelica Wallin, conducted an unannounced Annual Required Inspection and was met by co-licensees, Shanae Perges and Carlean Leavell. Hours of operation are from Monday to Friday from 7:00 am – 10:00 pm. LPA toured the home inside and outside and a census was taken.

This one - story home consists of 4 bedrooms and 3 bathroom. Areas used by the children include: day care room, one bedroom as the daycare room and isolation room, one bathroom, kitchenette and front yard. Per Licensee Perges, areas off limits to children include: 3 bedrooms, 2 bathrooms, living room, kitchen, den, and side yard. There are 0 children present during time of inspection. Licensee Perges stated that there are currently 5 children enrolled in the facility.

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 observe wall heater located in second day care room with anchored barricade. During inspection, LPA observed fire extinguisher with service tag dated 6/2021. A type B citation issued. LPA inspected kitchenette and observed cleaning supplies and chemicals located in child-proof locked cabinet under the sink inaccessible to children in care. LPA observed bathroom. LPA observed no hazardous items that can pose a danger to children. 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 Perges, outdoor play conducted in the front yard. LPA observed front yard fully enclosed and gated. LPA observed no hazardous items that can pose a danger to children. LPA advised licensee Perges that total supervision to be maintained at all times during outdoor play. LPA observed there no swimming pool or bodies of water.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: PERGES AND LEAVELL FAMILY CHILD CARE
FACILITY NUMBER: 197405743
VISIT DATE: 03/15/2024
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Per licensee Perges, food service is provided. Per licensee Perges, overnight care is not provided at this time. Per licensee Perges, transportation service is provided at this time. LPA discussed with licensee Perges supervision and safety when providing transportation services.

During inspection, no children present; thus, no children’s records reviewed. A review of staff records indicates that co-licensees have the following updated certificates: mandated reporter certificates with expiration date of 12/2025, and updated immunization records on file for measles, pertussis, influenza and TB clearance. During record review, LPA observed licensee Perges with updated pediatric CPR/First Aid certificate with expiration date of 1/2025. LPA observed co-licensee Leavell with no updated pediatric CPR/First Aid certificate. A type B citation issued. LPA reviewed the following documentation to be kept in facility: facility license, LIC610A, facility fire drill logs, PUB 394, and LIC9040. During inspection, LPA observed childcare roster dated 2022. Licensee Perges to update childcare roster adn submit picture evidence via email by 3/22/24. A technical violation citation issued.



Licensee Perges 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 Perges 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 Perges 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: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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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: PERGES AND LEAVELL FAMILY CHILD CARE
FACILITY NUMBER: 197405743
VISIT DATE: 03/15/2024
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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.
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Exit interview conducted and report was reviewed with co-licensee, Shanae Perges. 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: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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Document Has Been Signed on 03/15/2024 11:46 AM - It Cannot Be Edited


Created By: Angelica Wallin On 03/15/2024 at 11:15 AM
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: PERGES AND LEAVELL FAMILY CHILD CARE
FACILITY NUMBER: 197405743

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in fire extinguisher with service tag dated 6/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2024
Plan of Correction
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Per licensee, fire extinguisher to be re-serviced and picture proof as evidence to be submited via email.
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 co-licensee missing updated pediatric CPR/First Aid certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2024
Plan of Correction
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Per licensee, co-licensee to obtain updated CPR/1st aid card and submit picture proof evidence via email.
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: 03/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2024


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