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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419273
Report Date: 08/23/2021
Date Signed: 08/23/2021 05:49:09 PM

Document Has Been Signed on 08/23/2021 05:49 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WASHINGTON FAMILY CHILD CAREFACILITY NUMBER:
197419273
ADMINISTRATOR:WASHINGTON, NATASHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 731-7115
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 16DATE:
08/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Natasha Washington, LicenseeTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced annual inspection to the above facility on 8/23/21 at 3:30PM. LPA met with Natasha Washington, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Staff One (S1) and Adult One (A1). There were 16 child present upon arrival, which is a violation of title 22. Per licensee, she did not know her nieces and nephews counted in the capacity.

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. The children use the bathroom located through the office at the front of the house. LPA observed that there is a fireplace in the living room and is barricaded. Per Licensee, areas off limits to children and parents include: two bedrooms, one bathroom, kitchen, den, laundry room, backyard and back house. Back house is currently occupied by A2. Hours of operation are Mon-Sun 24 hours.

Individuals residing in the home have been discussed and noted. LPA observed an uncleared adult in the back house, which is a violation of Title 22. Per licensee uncleared adult is her niece and just stopped by to look at the daycare. Licensee states that there are no firearms or weapons stored in the home.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is operable telephone service at the facility via landline and cell phone. There is ventilation via fans and heat via wall heater in off limits area.

The following was observed and reviewed during this inspection:
LPA observed that cleaning products are stored in the laundry area, inaccessible to children. The licensee states that there are no poisons stored in the home. Isolation area for sick children waiting to be picked up is located in the office away from the other children. ------------------Page 1
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON FAMILY CHILD CARE
FACILITY NUMBER: 197419273
VISIT DATE: 08/23/2021
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The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. Children nap on cots in main care area. The bathroom that children use was observed to be clean and free of hazards.

Infant Care: Currently licensee cares for one infant 18 months old. Older Infant sleeps on a cot in the main care area. Licensee currently does not care for any other infants. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15 minute check documentation for infants 0-24 months, and provided PIN 20-24-CCP.

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 toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.



Children’s records were reviewed for emergency information.

The licensee and assistant do have proof of Pediatric CPR and first aid, expires 12/2021, proof of immunization against influenza/declination, pertussis, and measles, and Mandated Reporter AB 1207 compliant Child Care Training Certificate on file expires 6/2023, 7/2023.

LPA conducted COVID-19 Technical Assistance visit with licensee. LPA observed that licensee is still implementing COVID-19 precautions and procedures.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are two children enrolled that require IMS at
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON FAMILY CHILD CARE
FACILITY NUMBER: 197419273
VISIT DATE: 08/23/2021
NARRATIVE
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this time. 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Health and Safety Code 1596.7996 Effective January 1, 2019, Child Care Centers and Family Child Care Homes are required to provide parents and guardians of children enrolled, enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations and options for locations of affordable blood lead tests. 2019 Lead flyer Provided.

Based on the LPA’s 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.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.



A copy of the Parent Notification Requirements was provided to the licensee, along with a copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Natasha Washington, Licensee, including, but not limited to Appeal Procedures and Appeal Rights.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/23/2021 05:49 PM - It Cannot Be Edited


Created By: Denise Gibbs On 08/23/2021 at 05:04 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
, 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: 08/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2021
Section Cited
CCR
102416.5(a)

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102416.5(a) The capacity specified on the license shall be the maximum number of children for whom care can be provided.

This requirement was not met as evidenced by:
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During inspection seven children left. Per licensee she will have her sister pick up her own children from school to stay in capacity.
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Based on observation and interviews, licensee did maintain capacity on license. LPA observed 16 children in care. This poses an immediate Personal Rights risk to children in care.
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Type A
08/27/2021
Section Cited
CCR102370(c)

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Criminal Record Clearance 102370(c)
(c) All individuals subject to a criminal record review shall be fingerprinted

This requirement is not met as evidenced by:
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Uncleared adult left during inspection. Per licensee she will have her cleared before coming back to the facility
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Based on observation and interviews, licensee did not ensure all adults in the home had a fingerprint clearance. Uncleared adult Deshaneiah Muse. This poses an immediate Personal Rights 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:Trevino Cochran
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2021


LIC809 (FAS) - (06/04)
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