197419273-4-28-2023-54-CC-DGIS-CRBPQU-20230428113143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419273
Report Date: 04/28/2023
Date Signed: 04/28/2023 11:32:03 AM

Document Has Been Signed on 04/28/2023 11:32 AM - 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:	WASHINGTON FAMILY CHILD CARE		FACILITY NUMBER:	197419273
ADMINISTRATOR:	WASHINGTON, NATASHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 731-7115
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	04/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Natasha Washington, Licensee		TIME COMPLETED:	11:45 AM

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 9:15AM. LPA was initially met by Cynthia Washington, Facility Representative who guided analysts on a tour of the facility. Licensee Natasha Washington arrived at approximately 9:45AM. There was one daycare child upon arrival and one more arrived during inspection. LPA also observed one adult in the home. Facility in compliance for a large Family Child Care Home. This is a one-story home which consists of two bedrooms, two bathrooms, kitchen, dining room, living room, laundry room, office, den, detached back house, front yard and backyard (fenced). Main care is provided in the living room and dining room areas. Per Licensee, areas off limits to children and parents include: two bedrooms and one bathroom (separated by child safety gate), kitchen, den and laundry room (separated by a half door), backyard and back house. Hours of operation are Mon-Sun 24 hours. Licensee was reminded that a child cannot be in care a total of 24 hours. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. 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 for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 4/5/23. All documents were observed.----------------PAGE 1

SUPERVISORS NAME: Trevino Cochran
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: WASHINGTON FAMILY CHILD CARE	FACILITY NUMBER: 197419273
	VISIT DATE: 04/28/2023

NARRATIVE

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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, Natasha Washington.

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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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Document Has Been Signed on 04/28/2023 11:32 AM - It Cannot Be Edited

Created By: Denise Gibbs On 04/28/2023 at 11:04 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WASHINGTON FAMILY CHILD CARE	FACILITY NUMBER: 197419273
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2023

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in three out of three children's files, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/26/2023
	Plan of Correction
1 2 3 4	Per Licensee, she will update all files and will email LPA proof of documents by 5/26/23.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Two out of three children are missing signed consent for medical treatment, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/26/2023
	Plan of Correction
1 2 3 4	Per Licensee, she will update all files and will email LPA proof of documents by 5/26/23.

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:

Karen Chambers

LICENSING EVALUATOR NAME:

Denise Gibbs

LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

Page: 5 of 8

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: WASHINGTON FAMILY CHILD CARE	FACILITY NUMBER: 197419273
	VISIT DATE: 04/28/2023

NARRATIVE

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Overnight Care: Currently there are no overnight children in care. Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.

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). All documents observed. LPA observed that one child is missing a full file, two children are missing immunization records and one child is missing LIC 627.

Staff files were 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.

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):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. ---------------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)

Page: 3 of 8

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: WASHINGTON FAMILY CHILD CARE	FACILITY NUMBER: 197419273
	VISIT DATE: 04/28/2023

NARRATIVE

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Smoke and carbon monoxide detectors, located in the living room and hallway were tested and are operable. Fire extinguisher indicated fully charged and was last serviced 1/2022. Licensee was on her way to have the fire extinguisher serviced before inspection but came back with fire extinguisher to conduct annual inspection. Licensee will have fire extinguisher serviced when visit is completed. The home maintains telephone service via landline and cell phone. The inside of the home is observed to be clean and orderly. There are toys and other age appropriate material available for children in the main care areas. LPA observed a fireplace in the main care living room that is barricaded and inaccessible to children. LPA observed that detergents, cleaning compounds and medication are stored in the off limits kitchen and restroom with a child lock, inaccessible to children. LPA observed that the half door making kitchen inaccessible was left open on more than one occasion during inspection and gate leading to off limits bedrooms and bathroom does not lock. Licensee was reminded that gates need to be closed at all times during operating hours. Isolation area for sick children waiting to be picked up is in the office on the couch, away from the other children. Per Licensee, there are no firearms or weapons stored in the home.

The bathroom that children use is located through the office and was observed to be clean and free of hazards. LPA observed a changing table in the office for younger children.

Currently, children are using the front yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has age appropriate toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. Children do not have access to back yard, there is a gate on the side of the home that is locked. Detached back house remains locked during day care hours. There are no pools or spas, or other bodies of water.

Infant Care: Currently licensee has one infant enrolled. Infant was not present during inspection. LPA observed two play yards visible in the main care area. Play yards do not block entrances or exits. Standard mattresses for play yards were observed. LPA observed toys and blankets stored in the play yards. LPA reminded licensee that when infant is present, play yards must be free of all loose objects and play yards mats must have a tight fitted sheet. There are currently no infants with pacifiers. Per licensee wet or soiled sheets are as needed throughout the day. Licensee states the following a sleep supervision plan for infants: Infant naps in main care area where they can be supervised at all times.

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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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