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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494919
Report Date: 09/10/2021
Date Signed: 09/10/2021 01:36:25 PM

Document Has Been Signed on 09/10/2021 01:36 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:LI FAMILY CHILD CAREFACILITY NUMBER:
197494919
ADMINISTRATOR:LI LIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 207-0721
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
09/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Li LiTIME COMPLETED:
12:20 PM
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On 9/10/2021 at 9:30 a.m. Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with applicant Li Li for the purpose of a pre-licensing inspection of 6434 W. 87th Street, Los Angeles, CA 90045 The purpose of this visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The applicant is applying for a Large Family childcare license with a max capacity of 14. Property owner/landlord consent (LIC 9151) is on file. Property has a certificate of occupancy to allow the use of the detach garage. Certificate of occupancy has an address of 6434 ½ W. 87th Street, Los Angeles, CA 90045. The licensee rents the property with her two children. A copy of the rent/lease agreement was received.

Facility address has been licensed in the past , 2017-2021.

Per the application, currently, the ages the applicant wishes to provide services for children 2 to 5 years old with the hours of operation being Monday through Friday, 8 a.m. to 5:00 p.m.. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

The home is single-family home which consists of 3 bedrooms, 1 bathroom, living room and a permitted detached garage. ADU-Permit was received and file. The front yard is OFF LIMITS to the children in care and families will enter the facility through the side door. The driveway is enclosed with a self latching wooden gate. Pass the gate, you are led to the area of the childcare.

LPA observed the detached garage/day care space to have a open space with a bathroom and sink area.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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: LI FAMILY CHILD CARE
FACILITY NUMBER: 197494919
VISIT DATE: 09/10/2021
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parent board with all the necessary documents for parents was observed. A Fire extinguisher was observed near the entrance. Age appropriate toys such a puzzles, blocks, books and a dramatic play area were observed in the space. Children’s storage bins were observed around the space. Each storage bin had different age appropriate materials and toys. The space was observed to have a smoke and carbon monoxide detector. LPA observed a first aid kit in the area of the sink.

The bathroom that children will use was inspected. A toilet, a sink and shower were observed. The cabinet under the sink was observed to have safety latch. LPA observed napping cots stored in the bathroom.

A sink and cabinet space were observed right outside the bathroom. A microwave was observed that will be used to warm up the children’s lunch and/or snacks. Children will bring their own lunch and snacks.

The side of the detached garage/ day care space, is the designated outdoor space. The space was observed to have artificial turf. LPA observed a sand box, a wooden play structure and other age appropriate toys. Plants were observed to be fenced, ensuring the safety of the children in care.

LPA observed the home that will only use the living room space for napping and meals. The kitchen, bathroom and three bedrooms were observed and designated as OFF LIMITS to the children in care. The living room was observed to have a sliding door that leads to a deck. Children will only use the deck to access the living room for napping and meals.

The following items are pending prior to licensure to be completed by Tuesday, September 14, 2021.

Facility Sketch: New facility sketch reflecting the use of the living room for napping and meals.

Declaration: Signed declaration from applicant stating she understands that only activities are allowed in the detached garage and napping, and meals will take place in the living room.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LI FAMILY CHILD CARE
FACILITY NUMBER: 197494919
VISIT DATE: 09/10/2021
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An exit interview was conducted and copy of this report was provided to applicant, Li Li. A follow up pre licensing visit will be scheduled if applicant is unable to submit corrections via email. A final decision of License issuance will be determined by the department unit licensing Manager.


The following was discussed with the applicant:

Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541


Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.
Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.
Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be must be kept current, as well as the roster and Drill Log additional forms can be obtained from Maintained At The Facility - Family Child Care Home. Applicant was reminded that all documents for children's records the Department website: www.ccld.ca.gov
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LI FAMILY CHILD CARE
FACILITY NUMBER: 197494919
VISIT DATE: 09/10/2021
NARRATIVE
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FORMS TO BE POSTED
· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster
Children’s records requirements:
· LIC 700 Identification and Emergency Information
· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· Immunization record
· PUB 72- Family Child Care Consumer Guide
· LIC 995A Notification of Parent’s Rights
· CDPH 286 (Immunization Blue Card)
FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Landlord Consent Form, if you plan to care for more than 6 children for a Small
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates

· Copy of your deed or lease/rental agreement


· Documentation of Fire and Disaster drills
· Proof of immunization's against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandated reporterca.com – renewed every two years.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LI FAMILY CHILD CARE
FACILITY NUMBER: 197494919
VISIT DATE: 09/10/2021
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Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.



Applicant was informed about SAFE SLEEP PRACTICES and was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). LPA provided applicant with SAFE to SLEEP handouts. Applicant was also informed that the provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

Safe Sleep Links:AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH:https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative


Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.
·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 and a valid criminal record clearance associated to the facility license.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LI FAMILY CHILD CARE
FACILITY NUMBER: 197494919
VISIT DATE: 09/10/2021
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·Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
·Changes should be reported the to the Department as soon as they occur such as construction and remodeling.
·Telephone number changes and/or if you move from home
·Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference
·Fire and safety drills must be performed every six months and documented for review by the Department. (Child care Fire Drill log provided to applicant)
·All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
·Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
·LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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