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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419356
Report Date: 09/29/2021
Date Signed: 09/29/2021 01:50:14 PM

Document Has Been Signed on 09/29/2021 01:50 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:LAVELLE FAMILY CHILD CAREFACILITY NUMBER:
197419356
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
09/29/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Traci Lavelle, LicenseeTIME COMPLETED:
02:00 PM
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On 09/29/2021 at 11:15 AM, Licensing Program Analysts (LPA) Adrian Risher arrived at the home to conduct a Case Management visit for the purpose of an inspection for a proposed capacity increase. LPA was advised that the Licensee was not home and would return at 12:30pm. LPA returned to the home at 12:39pm to conduct the inspection. LPA met with Traci Lavelle and toured the facility inside and out. The facility is applying for a capacity increase from 08 to 14. Upon arrival, 2 children were observed in care with 1 staff member. Hours of operation are Monday through Friday 23 hours. The fire clearance was granted on 09/20/2021 by inspector Steve Porras

The single family home has 4 bedrooms and 3 bathrooms. The daycare will consist of Bedroom 4 and Bathroom 3. These areas were inspected by LPA. The other bedrooms and rooms are considered off-limits and inaccessible. Applicant owns the home. The daycare room is used for daily activities, eating and napping. Licensee stated that they use cots for napping. LPA inspected the bathroom and did not observe any medications or poisons that could pose a potential risk to children in care. The kitchen was inspected during the visit. LPA did not observe any knives or sharp objects, detergents or cleaning supplies that would pose a potential risk to children in care. These items were made inaccessible to the children.

LPA observed age appropriate toys, furniture and activities for children while in care at the facility. LPA observed toys and play equipment on the patio as well as the outside play area. Licensee stated that she is in the process of removing some of the play equipment in the yard so that she can purchase new ones. LPA did not observe any bodies of water in the home.

LPA observed a charged fire extinguisher. LPA tested the smoke detector and carbon monoxide detector. Applicant has a first aid kit which includes band aids and a thermometer. The home has central air and heat.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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: LAVELLE FAMILY CHILD CARE
FACILITY NUMBER: 197419356
VISIT DATE: 09/29/2021
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Applicant has current CPR, first aid, health and safety.. Per the applicant, there are no firearms on the premises. Applicant reports that she has 1 dog who stays in her bedroom. The parent board will be posted for parents to view required information such as the license, parent's rights poster, personal rights, and emergency disaster plan. A copy of the children's roster will be kept accessible. LPA reviewed copies of immunization records and mandated reporter training has been reviewed and completed.

A license to operate a Large Family child care home will be reviewed following final administrative review, and receipt of outstanding corrections needed. No license will be issued today 09/29/2021. Applicant will notify LPA when corrections have been made, and the Applicant has 30days to complete corrections.

The following was dicussed with the Licensee:
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

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Traci Lavelle. Appeal rights have been reviewed and provided.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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