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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412659
Report Date: 08/17/2022
Date Signed: 08/17/2022 12:41:46 PM

Document Has Been Signed on 08/17/2022 12:41 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:MORRIS FAMILY CHILD CAREFACILITY NUMBER:
197412659
ADMINISTRATOR:MORRIS, JUDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 751-2966
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 3DATE:
08/17/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Judy Morris, Licensee TIME COMPLETED:
12:50 PM
NARRATIVE
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On 8/17/2022 10:36Am Licensing Program Analyst (LPA) Miranda conducted an inspection - deficiency at Morris Family Child Care, for the purpose of the health and safety of the child care. LPA observed Licensee with 3 children in care (one was infant).

The following deficiencies were observed on 08/17/2022 and advisory notes was provided to Licensee:


The licensee was not able to provide complete children’s files for child#5,#6 and #7 and was not able to produce the children’s files for child#2 and #3.

Licensee was unable to produce files for Staff#1 and #2

LPA was guided on a tour of the home (inside and outside) and observed that at the living - room have 2 bouncers and one baby exersaucer, 2 swingers and one car seat, no child was observed using this equipment’s and one car seat at the outdoor area. LPA provided to Licensee consultation regarding Health and Safety Code.

During this inspection, LPA obtained an updated LIC279 Application for a Family Child Care Home and LIC279B Current Children in your Home and declaration of plan of correction regarding items and similar items that is prohibited at the facility.

LPA and Licensee discussed 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, see lic809-D deficiency is cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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Document Has Been Signed on 08/17/2022 12:41 PM - It Cannot Be Edited


Created By: Denise Miranda On 08/17/2022 at 11:23 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: MORRIS FAMILY CHILD CARE
FACILITY NUMBER: 197412659

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2022
Section Cited
CCR
102421(b)

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Child's Records - The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7). This requiremen is not met as evidenced by on 8/17/2022 based, On LPA file review and observation, LPA
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The licensee understands that a record / file with required documents must be on the premises for every child that is enrolled or no longer attending the facility that shall keep for 3 years.
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observed 2 children without files and 3 chdlren with incomplete file. This is a potential risk to the health and safety of children in care.
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License will provide copies of the children's file no later than 8/36/2022 via mail to LPA Miranda along with immunization card.

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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Denise Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2022


LIC809 (FAS) - (06/04)
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