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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408767
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:02:00 PM

Document Has Been Signed on 06/28/2022 12:02 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:ROLLINS FAMILY CHILD CAREFACILITY NUMBER:
197408767
ADMINISTRATOR:ROLLINS, DEANNE J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 457-2048
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:Licensee Deanne RollinsTIME COMPLETED:
12:05 PM
NARRATIVE
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On 06/28/2022 at 8:41 a.m., Antonio Almanza, Licensing Program Analyst (LPA), conducted an unannounced Annual Required Inspection at the licensed family child care home. LPA met with Deanne Rollins, Licensee, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Thursday from 9:00 a.m. to 2:00 p.m.

The home is a two-floor home located on a slope. The main home is accessed through the top floor. The bottom level of the home is where childcare is provided. There is a ramp on the right side of the home that leads to the childcare area of the home. The childcare space consist of two rooms and bathroom located on the bottom level of the home. There is working c/o and smoke detector in the main childcare room. There is a fire extinguisher on the doorway in front of the stairs. The Fire extinguisher does not have service record and the license does not have a receipt to show when it was purchased. There is a pull down alarm in the main room. There is a first aid kit in the main room closet area.

There is no swimming pool or other bodies of water on the premises. During the visit, LPA did not observe firearms or weapons; and Licensee states there are none on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. Furniture and equipment are in good condition, free of sharp, loose or pointed parts.

Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There are 24 steps in the back yard that lead to a second play area. This area has a a wooden post railing along the side, of a slope, there is no fencing around this area. Capacity and limitations as specified on the license are being maintained.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 06/28/2022 12:02 PM - It Cannot Be Edited


Created By: Antonio Almanza On 06/28/2022 at 10:28 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ROLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197408767

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in the licensee and two assistance do not have a current Mandated Reporter Training, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Licensee and 2 assistants will complete Required training and provide to LPA by 07/15/22.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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 Licensee does not have current Immunization's (influenza, pertussis, and measles) for two assistants, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Licensee will get immunization records from assistants and provide LPA a copy by 07/15/22.
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:Lisa Rios
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022


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Document Has Been Signed on 06/28/2022 12:02 PM - It Cannot Be Edited


Created By: Antonio Almanza On 06/28/2022 at 10:28 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ROLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197408767

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

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 2 of 8 files reviewed (Child 1 and Child 2) do not have Immunization records on file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Licensee will get immunization's records for the 2 children in care and provide LPA a copy by 07/15/22.
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:Lisa Rios
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022


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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: ROLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197408767
VISIT DATE: 06/28/2022
NARRATIVE
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Licensee has current Pediatric First Aid CPR, completed on 10/26/2021. Licensee and 2 Assistants do not have Mandated Reporter Training on file. The Licensees 2 Assistants do not have Influenza, Pertussis, And Measles on file. LPA reviewed a sample of children’s files and observed 2 of 8 files (Child 1 and Child 2) missing immunization records.

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 [or facility representative] 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.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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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: ROLLINS FAMILY CHILD CARE
FACILITY NUMBER: 197408767
VISIT DATE: 06/28/2022
NARRATIVE
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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations and Health & Safety Code, the following deficiencies are being cited: (see next page, 809 D). Licensee was provided a copy of their appeal rights.

- Facility Administration - Type B: 1596.8662(b)(1) - The licensee and two assistance do not have a current Mandated Reporter Training.

- Records - Type B: 1597.622(a)(1) - Licensee does not have current Immunizations (influenza, pertussis, and measles) for two assistants.

- Records - Type B: 102418(g) - 2 of 8 files reviewed (Child 1 and Child 2) do not have Immunization records on file.

- H&S - 1597.46(f) - Large family day care homes -Licensee has a fire extinguisher that has not have a service date record or receipt of purchase.

- Records - Technical Violation: 102417(g)(8) - The licensee has a roster but the roster does not contain physician information.

- Facility Administration - Technical Violation: 102370(d) - Licensee Assistant (Adult 1) turned 18 on 06/27/22. Licensee will have assistant get criminal record clearance today 06/28/22.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Deanne Rollins.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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