197415189-4-28-2023-54-CC-DGIS-CRBTP3-20230428145341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415189
Report Date: 04/28/2023
Date Signed: 04/28/2023 02:53:52 PM

Document Has Been Signed on 04/28/2023 02:53 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	MATTHEWS FAMILY CHILD CARE		FACILITY NUMBER:	197415189
ADMINISTRATOR:	MATTHEWS, SHAMECKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 868-2457
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 3	DATE:	04/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Shameka Matthews, Licensee		TIME COMPLETED:	03:15 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 Analyst (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 4/28/23 at 12:00 PM. LPA met with Shameka Matthews, Licensee who guided analysts on a tour of the facility. There were three daycare children and one adult(assistant) present when LPA arrived. Facility in compliance for a large Family Child Care Home. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. This is a one-story home which consists of three bedrooms, one full bathroom, one half bathroom, Living Room, Dining Room, Kitchen, Laundry Room, Detached Garage, front yard (not fenced) and backyard (Fenced). Main care is provided in bedroom #3 toward the back of the home. Areas off limits to children and parents include: living room, dining room, kitchen, two bedrooms, and full bathroom. Hours of operation are Mon-Fri 7:00 AM- 6:00 PM. Food is provided by Licensee. Entrance to the facility is down the right side of the home through the back entrance. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation which includes; Facility License, Publication (PUB) 394- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan and (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster and Disaster drill log, last drill conducted on 4/18/23. All documents were observed. ----------------PAGE 1

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATTHEWS FAMILY CHILD CARE	FACILITY NUMBER: 197415189
	VISIT DATE: 04/28/2023

NARRATIVE

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During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

Incidental Medical Services (IMS):
This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personal, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA's observations and records review no deficiencies will be cited today 4/28/23.

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 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.

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

Exit interview conducted and report was reviewed with the Licensee, Shameka Matthews. --------PAGE 3

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATTHEWS FAMILY CHILD CARE	FACILITY NUMBER: 197415189
	VISIT DATE: 04/28/2023

NARRATIVE

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LPA observed a child safety gate on the entrance to the daycare room which makes the rest of the home inaccessible. Dual smoke and carbon monoxide detector, located in the kitchen was tested and is operable. Fire extinguisher indicated fully charged and was last purchased, 4/19/23. The home maintains telephone service via landline and cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available in the daycare room. LPA observed that detergents, cleaning compounds and medication are stored in the kitchen and laundry room, inaccessible to children. Isolation area for sick children waiting to be picked up is in the dinning room, away from the other children. Per Licensee, there are no firearms or weapons stored in the home.

The bathroom that children use is located inside the daycare bedroom and was observed to be clean and free of hazards.

Infant Care: Currently licensee has one infant in care. LPA observed one crib visible in the daycare room. Napping equipment does not block entrances or exits. Infant mattress was observed to be firm with tightly fitted sheet. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the crib. There are currently no infants with pacifiers. Bedding is washed twice a week. Wet or soiled sheets are changed as needed throughout the day. Licensee states the following a sleep supervision plan for infants: Licensee can visually observe infant while sleeping and checks infant every 15 minutes.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. Detached garage remains locked during daycare hours. There are no pools or spas, or other bodies of water.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Right, and documentation of 15-minute Infant Sleep Check (0-24 months). Children's records were discussed.

Staff records reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. All documents observed. ----PAGE 2

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

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