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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411153
Report Date: 08/11/2021
Date Signed: 08/19/2021 03:16:15 PM

Document Has Been Signed on 08/19/2021 03:16 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:JOHNSON FAMILY CHILD CAREFACILITY NUMBER:
197411153
ADMINISTRATOR:JOHNSON, LA TRICIA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 753-4453
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
08/11/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:56 PM
MET WITH:LATRICIA JOHNSONTIME COMPLETED:
07:10 PM
NARRATIVE
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On 08/11/2021 at 2:56 pm Licensing Program Analyst (LPA) Laticia Thompson and (LPA) Deborah Lowe conducted an unannounced visit to Johnson Family Childcare to investigate a complaint. LPA Thompson informed Licensee La Tricia Johnson the purpose of the visit was to conduct an investigation.

Licensee toured LPA’s Thompson and Lowe into home facility. LPA’s Thompson and Lowe observed 1 child in care.

During course of investigation LPA’s Thompson and Lowe observed the following deficiencies at the facility:

· Cleaning chemicals were observed accessible to children. LPA’s observed multiple hazardous, poisonous material in the kitchen. LPA observed bottles of cleaning solution under the kitchen sink in an unlatched cabinet. Cleaning spray observed on kitchen table accessible to children.
· Sharp objects were observed in the kitchen accessible to children. LPA’s Thompson and Lowe observed 1 knife on the kitchen counter and multiple knives in an unlatched kitchen drawer.

· Medication bottle was observed to be accessible to children in the hallway on the floor under an end table. Medication was also observed in two children’s cubbies

· Licensee was unable to provide LPA with a roster of children currently enrolled. Upon arrival, LPA Thompson requested licensee to provide a current roster and children records. Licensee was only able to provide 3 out of 6 children’s files and did not produce a current roster. LPA Thompson requested licensee to provide CPR/First Aide and Mandated Reported certification information, licensee was unable to provide. Stated she would provide documents later.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 197411153
VISIT DATE: 08/11/2021
NARRATIVE
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  • Children’s files reviewed were observed to be incomplete, missing immunization records along with other current documentation.

  • LPA’s observed hazardous material in the bathroom accessible to children in the form of hair products.
  • Licensee would not allow LPA's to inspect the masterbedroom located next to the children activity area.

The facility is cited Two Type A violations. See LIC809-D for details. Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection).

The facility is cited two Type B violations.

An exit interview was conducted with the Licensee, La Tricia Johnson, in which this report was read to her. LPA provided licensee with a copy of this report, a Notice of Site Visit (LIC 9213) and Appeal rights. Licensee was cited two Type A deficiencies, and two Type B deficiencies according to California Code of Regulations Title 22 (see LIC 809D report for deficiencies).

The Licensee was advised that the Notice of Site Visit and a copy of this report must be posted at the entrance of the facility for a period of 30 days.

In addition; A copy of this report must be provided to a parent or an authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/19/2021 03:16 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 08/11/2021 at 05:33 PM
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: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 197411153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/11/2021
Section Cited
CCR
102417(g)(4)(a)

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102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child.., .(4) Poisons, detergents, cleaning compounds.This requirement was not met as evidenced based on
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Licensee will review video and provide proof of completion by 08/23/2021 & will provide pictures of corrections.

https://ccld.childcarevideos.org/family-child-care-providers/locks-and-inaccessibility-regulations-in-child-care/
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LPA's observation of cleaning material in several areas of the home were accessible to children. Licesee failed to store knives in an area inaccessible to children. This poses an immediate Health and Safety risk to children in care.
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Type A
08/11/2021
Section Cited
CCR102391(d)(1)

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102391 (d) The licensee shall permit the Department to inspect, audit, and copy children's records or other family child care home records upon demand during normal business hours. This requirement was not met as evidenced based on
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Licensee will review video and provide proof of completion by 08/23//2021.
https://ccld.childcarevideos.org/family-child-care-providers/community-care-licensing-inspection-authority/
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Licensee refused to allow LPA's to inspect a bedroom. This poses an immediate Health and Safety risk to children in care.
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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:Peter Flores
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2021


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/19/2021 03:16 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 08/17/2021 at 02:18 PM
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: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 197411153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2021
Section Cited
CCR
102417(g)(8)

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102417(g)(8) Operation of a Family Child Care Home. Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not met as evidence by
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Licensee will provide LPA with a completed and current roster of all children enrolled in the facility. Licensee agrees to maintain, update and keep roster available in a central location of the facility. Licensse will retain roster for 3 years.
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Based on observation, interview and record review licensee was unable to provide a roster for children currently enrolled in the facility which poses a potential Health, Safety, or Personal Rights Risk to children in care.
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Type B
08/11/2021
Section Cited
CCR102417(g)(7)

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102417 Operation of a Family Child Care Home (g)(7) An emergency information card shall be maintained for each child...include the child's full name, telephone number and location of a parent or other...to be contacted in an emergency... the name and telephone. This requirement was not met as evidence by
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Licensee will provide LPA with copies of 5 children files with all dcoumentation according to LIC 311D by 08/23/2021. Licensee agrees to maintain, update and keep files current and available in a central location of the facility.
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Based on observation, interview and record review licensee was unable to provide complete children files. Files were missing immunizaiton records and emergency contact information.
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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:Peter Flores
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2021


LIC809 (FAS) - (06/04)
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