<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407189
Report Date: 11/25/2024
Date Signed: 11/25/2024 06:07:41 PM

Document Has Been Signed on 11/25/2024 06:07 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GRAY FAMILY CHILD CAREFACILITY NUMBER:
197407189
ADMINISTRATOR/
DIRECTOR:		GRAY SHELLY LYNNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 892-0688
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
11/25/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:35 PM
MET WITH:Shelly Lynn Gray, LicenseeTIME VISIT/
INSPECTION COMPLETED:
06:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Elicia Calvillo conducted an unannounced 3 Year Required Annual inspection to the above facility on 11/25/2024. LPA arrived at the facility at 03:45 PM, identified self and met with Shelly Lynn Gray, Licensee, who guided analyst on a tour of the inside and outside of the facility. There were 10 children and 1 staff present at arrival. LPA provided Licensee with a copy of the LIC125 Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Friday from 07:30AM to 05:30PM.

The family child care home is a one story dueling with a living / dining room, kitchen, laundry room, 3 bedrooms, 2 bathrooms, play room, and attached garage. There is a fenced front yard that is off limits to children. There is a fenced outdoor play area in the back of the house.

LPA observed the following inside areas will be used for child care: living / dining room, kitchen, laundry room, play room, and bathroom #2 are used for providing care and are accessible to children. The children enter the facility from the door located on the side of the house. The play room is used for dropping off and picking up children, learning activities, arts and crafts, play activities, eating and sleeping. In the play room, LPA observed mats, bed linens stored in the cabinet and observed toys and play items that are safe, clean, and appropriate for the ages of the children. The living / dining room is used for isolation or extra space, kitchen is used to prepare food and is made inaccessible to child with the use of child latches, the laundry room is use as a walk way to the bathroom and is made inaccessible with the use of child latches.

Bathroom #2 located next to the play room is used for children. The vanity cabinet holds hand soap and paper products, has a child safety latch, and no hazards were observed. LPA observed that the bathroom that children use was safe and sanitary.

PAGE 1 OF 5

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRAY FAMILY CHILD CARE
FACILITY NUMBER: 197407189
VISIT DATE: 11/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
All other rooms are off-limits and made inaccessible by use of door locks. There is telephone service via a cellphone and License stated the cellphone stays at the facility during the hours of operation.

Licensee stated that when a child shows signs of an illness the child will isolated away from the other children in the living / dining room.



There is a combination smoke detector located in the play room and carbon monoxide detector located in the living / dining room and both were tested and are operable.

There is a working fire extinguisher, the valve on the required 2A 10BC fire extinguisher indicates fully charged and Licensee was not able to confirm last service date.

The outdoor play area is located in the back yard of the house, is fenced and there are no hazards to children present. LPA observed appropriate toys and other play equipment for children in care. LPA observed a climbing structure that is secured to the ground and the ground underneath and around is covered with pea gravel to absorb falls.


LPA did observe a pool during the inspection on the property. The fence is designed and installed so children could not remove any portion of it, it completely surrounds the pool, is constructed so that it does not obscure the pool from view, no window or door provides direct access to the pool. Fence is at least 5 feet high (photo taken). The opening between the railing does not exceed 4 inches (photo taken). The gate swings away from the pool, self closes, and self-latches.

Per Licensee, there are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible with the use of a safety latch.



Licensee has two dogs, during the hours of operations the dogs are kept in the pool area and the pool is inaccessible to children.

PAGE 2 OF 5

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRAY FAMILY CHILD CARE
FACILITY NUMBER: 197407189
VISIT DATE: 11/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA did not observe a fireplace or an open-faced heater.

There are currently infants in care under the age of 12 months. Licensee states that infants will sleep in the play room where they are constantly supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age and reference Provider Information Notice (PIN) 20-24 CCP.



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 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.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA reviewed a sample of children’s files and observed files were complete and documented on the LIC857.

There was 1 personnel record for LPA to review and observed the file was complete and documented on the LIC869.

PAGE 3 OF 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRAY FAMILY CHILD CARE
FACILITY NUMBER: 197407189
VISIT DATE: 11/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
An emergency fire/disaster drill has been completed within the last 6 months on 11/12/2024 and the documentation of the fire/disaster drill was not readily available upon request. Licensee’s Mandated Reporter Training was completed on 05/17/2024. Licensee’s pediatric CPR/First Aid expires on 06/2025.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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.



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.

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/.


PAGE 4 OF 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GRAY FAMILY CHILD CARE
FACILITY NUMBER: 197407189
VISIT DATE: 11/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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-care­ licensing/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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there are no deficiencies being cited today.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Shelly Lynn Gray, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

PAGE 5 OF 5
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5