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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493929
Report Date: 09/28/2021
Date Signed: 09/28/2021 05:55:30 PM

Document Has Been Signed on 09/28/2021 05:55 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:CARTER FAMILY CHILD CAREFACILITY NUMBER:
197493929
ADMINISTRATOR:MICHELLE CARTERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 469-8513
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Michelle Carter, LicenseeTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. Upon arrival LPA introduce and identify themselves to Michelle Carter, Licensee and explained the purpose of the inspection. LPA explain that the facility will be inspected using the Inspection Tools, and explain that the LPA and licensee will jointly address any deficiencies of licensing statutes, regulations, and interim licensing standards identified during the inspection.LPA provided licensee with and explained the facility Entrance Checklist, LIC 126,and requested that the items on the sheet be made available for inspection. Licensee provided tour of facility LPA inspected rooms/areas on the facility sketch in which child care services are provided and to which children have access. There were no children in care. Per licensee there are currently no children enrolled.

All adults living in the facility have obtained criminal record clearance. All individuals living in the home were discussed and noted.

The home is a 3 bedroom, 2 bathroom home with detached garage, front, side and backyard.


Per licensee the areas for day care will be conducted in the living room, two bedroom (bedroom #1 in the front of home and bedroom #3 located in the rear of the home), yard located on right side of the home.

Areas Off Limits to children in care are: the kitchen, one bedroom, one bathroom, front and backyard, driveway (on the left side of home and detached garage in the backyard. All off limit areas are made inaccessible by lock or gate. Telephone service, heating, lighting and ventilation were evaluated and in good condition. First Aid Kit complete and present in the home. The open face heater in the living room and in the back bedroom were observed to be screened to prevent access by children in care. Furniture and equipment was inspected for age appropriateness and good repair. The restroom that children use were observed to be safe and sanitary. A land line is available in the home.
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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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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Document Has Been Signed on 09/28/2021 05:55 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 09/28/2021 at 10:48 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: CARTER FAMILY CHILD CARE
FACILITY NUMBER: 197493929

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on facility record review, the licensee did not comply with the section cited above, since the licensee did not have the required mandated reporter certificate available for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/15/2021
Plan of Correction
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Per licensee, a copy of the mandated reporter training will be provided to the department via email by POC due date.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee record review, the licensee did not comply with the section cited above due to licensee's Influenza immunization was not available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/15/2021
Plan of Correction
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Per licensee, a copy of the proof of Imfluenza Immunization will be provided to the department via email by POC duie date.
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2021


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 09/28/2021 05:55 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 09/28/2021 at 10:48 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: CARTER FAMILY CHILD CARE
FACILITY NUMBER: 197493929

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2021

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
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Based on record review, the licensee did not comply with the section cited above since licensee did not have a copy of a current EMSA certified Pediatric First Aid/CPR training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/15/2021
Plan of Correction
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Per licensee, a copy of the EMSA certified Pediatric First Aid/CPR training certificate will be provided to the department via email by POC due date.
Section Cited
General Provisions and Definitions
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2021


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: CARTER FAMILY CHILD CARE
FACILITY NUMBER: 197493929
VISIT DATE: 09/28/2021
NARRATIVE
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. Per licensee, there are no poisons stored in the premises. Licensee understands that storage areas for poisons must be locked with a key or combination lock. Per Licensee, they currently have no assistants.

Licensee has no infants in care infants. Licensee states that when infants are enrolled infants will sleep in one of the front bedroom where they will supervised at all times.

Currently, children are using the back yard( located on side of home) for outdoor play time. 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. Licensee was advised to maintain toys and equipment in good repair.

LPA reviewed the facility and staff files and observed the following: LPA observed that the Licensee does not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file, the licensee was missing the current EMSA certified CPR/First Aid certificate This poses a potential risk to the health safety of children in care.


LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection.

The following was discussed:

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization, and a valid criminal record clearance associated to the facility license.

The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Fire and safety drills must be performed every six months and documented for review by the Department.

- No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.


- Smoking is prohibited in a family child care home, 24/7.
- All adults living and working in the home shall be made of aware of the Departments right to inspection authority.
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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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: CARTER FAMILY CHILD CARE
FACILITY NUMBER: 197493929
VISIT DATE: 09/28/2021
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/inspection-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 Michelle Carter.

End of Report Page 4 of 4

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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: CARTER FAMILY CHILD CARE
FACILITY NUMBER: 197493929
VISIT DATE: 09/28/2021
NARRATIVE
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- Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.
- Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
- Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

- LPA Provided Lead Bill Flyer AB2370 - Effects of Lead Exposure.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements were reviewed.

Changes reported to the Department as soon as they occur: such as construction, remodeling, telephone number changes and/or if you move from your home.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.


LPA provided Licensee with a copy LIC 311D as a reminder of the required documents to be maintained in the facility files.

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

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
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