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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494120
Report Date: 02/04/2025
Date Signed: 02/04/2025 04:13:21 PM

Document Has Been Signed on 02/04/2025 04:13 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SAMPSON FAMILY CHILD CAREFACILITY NUMBER:
197494120
ADMINISTRATOR/
DIRECTOR:		SAMPSON, ROBINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 986-5056
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 1DATE:
02/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:SAMPSON, ROBIN / LICENSEETIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Ashley Calderon and Tyler Reyes conducted an unannounced annual/ random inspection at the above facility. LPAs met with Licensee Robin Sampson who granted LPA entrance to the facility. LPA's disclosed purpose of today's visit.

Upon arrival LPA's observed two adults and zero children. Adults present was Licensee and Licensee's family member. Individuals are fingerprinted cleared. At approximately 2:00pm after school child #1 arrived at the facility, child uses school transportation bus to get dropped of to the facility. Per licensee, currently not caring for any infants.

Facility capacity is in compliance for Large Family Child Care Home. Hours of operation are Monday- Friday, 6am-6pm. LPA's conducted a guided tour of the facility inside and out along side with R.Sampson.

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:

This is a one story home which consists of three bedrooms and one bathroom. Areas used by the children include the Day Care room, two bedrooms, bathroom, living room, front yard, and backyard. Areas off limits to children include the kitchen/dining area (used as a passageway only), and one bedroom.

The bathroom that children use was observed to be clean and free of hazards. LPA observed cleaning component in the bathroom cabinet under the sink. Cabinet door is inaccessible to the children in care, Licensee has baby safety magnet latch on door. Kitchen was observed, knives are located in an inaccessible cabinet with baby safety latch in place and chemicals observed under the kitchen sink cabinet has baby latch in place making area inaccessible to children. (Cont..)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SAMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197494120
VISIT DATE: 02/04/2025
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Per Licensee, provides food to the children in care. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

LPA reviewed required posted documentation for Facility License and Publication (PUB) 394- Notification of Parent Rights and Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster was updated, Disaster drill log posted, last drill conducted on February 3, 2025. Licensee has the appropriate amount of Liability Insurance bond amount required by the Department.

Smoke detector was tested and are operable. LPA observed a carbon monoxide detector in the day care room. Licensee has a fire alarm pull system interconnected to the Los Angeles Fire Dept. Fire extinguisher indicated fully charged and was serviced within the year, inspected on 1/2/25. Open face heater is screened to prevent access by children.

The home maintains telephone service via cell phone. Per LPA's observation and licensee stated there are, no pets, no guns at the home, no fireplace and no poisons. LPA's observed toys and other age appropriate material available for children. Per licensee, no child on medications. Per Licensee, if child was to display illnesses, Licensee uses napping bedroom as the isolation room.

LPA observed 1 play yard for infants. Outdoor was observed there are 3 locked sheds in the back yard. Per Licensee, children are currently not using the backyard. No bodies of water was observed. The home is observed to be clean and orderly.

LPA reviewed 4 children files, and 1 staff file, Licensee had all appropriate documentation's in each individuals files. Licensee's Pediatric First Aid and CPR expires: 9/2025 and Mandated Reporter Training expiration date 1/11/27.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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. (LIC809-C Continuation...)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SAMPSON FAMILY CHILD CARE
FACILITY NUMBER: 197494120
VISIT DATE: 02/04/2025
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee [was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on today’s visit, Per California Code of Regulations Title 22 there were no citations given today. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Robin Sampson.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
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