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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494665
Report Date: 12/16/2021
Date Signed: 12/16/2021 02:46:56 PM

Document Has Been Signed on 12/16/2021 02:46 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:LUU FAMILY CHILD CAREFACILITY NUMBER:
197494665
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
12/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Josephine LuuTIME COMPLETED:
03:00 PM
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On 12/16/2021 at 9:30 am Licensing Program Analyst (LPA), Deborah Lowe conducted an unannounced Annual Required Inspection and was met by Licensee, Josephine Luu. Licensee verified days and hours of operation are Monday – Friday 7:00 am to 6:00 pm.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the kitchen as a walk through to access the bathroom, bedroom #1, living room, and family room (child care room) are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of doors with child proof door handle covers. Family room is used for child care and is enclosed with use of child safety gate. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises.

Facility was observed with two guest houses in the back of the home. Licensee stated they were studio size guest houses rented out by the owner of the property with two separate tenants. Tenants have access to the guest house though a gate on the right side of the home. Guest house is attached to the main home with no access from inside the main home. Children’s outdoor play area is located on the left side of the home with a child safety gate preventing access to the guest houses. Children were not observed to have access to the guest houses.



All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The fireplace located in the family room is made inaccessible by a glass door and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are three stairs from the living room to the family room. Stairs are barricaded by the use of a child safety gate when children under age

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LUU FAMILY CHILD CARE
FACILITY NUMBER: 197494665
VISIT DATE: 12/16/2021
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5 years old are present. The home has working cell telephone service and LPA confirmed the phone number is (818) 439-4076.

There were two infants observed during visit. Licensee stated they have three infants enrolled. LPA discussed Safe Sleep Regulations with licensee. There is a play yard for two infant in care, third infant sleeps on a cot. LPA advised play yards are kept free from all loose articles and objects while infants are sleeping. Toys were observed in the play yards, Licensee removed items during visit, no children were observed using the play yards at the time. LPA observed no objects hanging above or attached to the crib or play yard. LPA advised Infants are not swaddled while in care. Licensee stated they physically check on sleeping infants every fifteen minutes, however; has not been documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infant play yards for napping were observed in the day care area (family room) in full supervision of Licensee. Individual Infant Sleeping Plan is not completed and is not in the file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

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 is located on the side of the home and is fenced and there are hazards to children present. Metal screen covers for under home located outside in outdoor play area one was observed with a hole filled with a piece of concrete and a second screen is not secured in place and side is accessible to children. Capacity as specified on the license is being maintained.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. LPA Lowe observed the log to be completed with fire/disaster drill completed monthly. Licensee’s Mandated Reporter Training was completed on 05/28/2020. Licensee’s pediatric CPR/First Aid expires on 06/2022. 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 main home where child care is provided have a criminal record clearance or exemption. There are no excluded individuals present at the main home.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
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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: LUU FAMILY CHILD CARE
FACILITY NUMBER: 197494665
VISIT DATE: 12/16/2021
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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.

Incidental Medical Services (IMS) are currently being provided.


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

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.

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.

LPA Lowe reviewed and provided licensee with LIC 311 Forms/Records to Keep in Your Family Child Care Home, LIC 9227 Individual Sleep Plan, and PIN 20-24 Safe Sleep Regulations.



Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D)

Licensee was provided a copy of appeal rights.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
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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: LUU FAMILY CHILD CARE
FACILITY NUMBER: 197494665
VISIT DATE: 12/16/2021
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 A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Josephine Luu.

During exit interview LPA Lowe discussed with Licensee the guest house and the guest house tenants.. Further research will be needed for the guest house and the background checks for those who live in the guest houses.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
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Document Has Been Signed on 12/16/2021 02:46 PM - It Cannot Be Edited


Created By: Deborah Lowe On 12/16/2021 at 02:10 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: LUU FAMILY CHILD CARE
FACILITY NUMBER: 197494665

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation of the outdoor play area, the licensee did not comply with the section cited above in the screens for the house crawl spaces were observed in need of repair. Screens are at child's level and have access which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2021
Plan of Correction
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Licensee called for handtyman service while LPA was present. Licensee will send pictures to LPA via email once repaired on or before 12/24/2021.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 infants with no safe sleep documentation, Licensee stated they are not documenting safe sleep observations which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2021
Plan of Correction
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Licensee will create a sleep log to docuement safe sleep observations for all infants 12 months and under. Licensee will email log created to LPA Lowe on or before 12/24/2021.
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:Karren Starks
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/16/2021 02:46 PM - It Cannot Be Edited


Created By: Deborah Lowe On 12/16/2021 at 02:10 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: LUU FAMILY CHILD CARE
FACILITY NUMBER: 197494665

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 infants enrolled do not have An Individual Infant Sleeping Plan (LIC9227) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/21/2021
Plan of Correction
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Licensee will have parents compelte An Individual Infant Sleeping Plan LIC 9227. Licensee will email completed LIC 9227 to LPA on or before 12/21/2021.
Section Cited
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:Karren Starks
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2021


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