197493912-11-19-2021-30-CC-JLAO-C8WT7H-20211119132842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493912
Report Date: 11/19/2021
Date Signed: 11/19/2021 01:29:14 PM

Document Has Been Signed on 11/19/2021 01:29 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:	NORRIS FAMILY CHILD CARE		FACILITY NUMBER:	197493912
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	11/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Gloria Norris		TIME COMPLETED:	01:00 PM

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On 11/19/2021 at 9:15 a.m., Licensing Program Analyst (LPA) Judy Laureano conducted an unannounced Annual Required Inspection and was met by Gloria Norris, licensee. Licensee is Spanish Speaking and inspection was conducted in Spanish. Days and hours of operation are Monday through Friday from 7:30 a.m. to 5:30 p.m.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed the areas that are OFF LIMITS to the children in care. Bedroom one is used for additional napping area. All other rooms are off-limits and made inaccessible by use of a safety gate.

There is no swimming pool or other bodies of water on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are is an open face heater in the home that is barricaded. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

Stairs in this home have a safety gate. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is 310-745-6678.

LPA did not observe any infants under 12 months care. Licensee confirmed that currently the facility does not have infants under 12 months of age enrolled in the program. LPA discussed Safe Sleep Regulations with licensee.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

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: NORRIS FAMILY CHILD CARE	FACILITY NUMBER: 197493912
	VISIT DATE: 11/19/2021

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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed, 2/16/2020. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

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 Tittle 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited:(see next page, 809D) Licensee was provided a copy of their appeal rights.

This report shall be made available to the public upon request. An exit interview was conducted with Licensee and the LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/19/2021 01:29 PM - It Cannot Be Edited

Created By: Judy Laureano On 11/19/2021 at 11:43 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: NORRIS FAMILY CHILD CARE	FACILITY NUMBER: 197493912
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/19/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. 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 which is a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/03/2021
	Plan of Correction
1 2 3 4	Licensee agrees to complete CPR and First Aid and submit proof of completition via email by 12/3/21.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Maureen Neal

LICENSING EVALUATOR NAME:

Judy Laureano

LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

LIC809 (FAS) - (06/04)

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