197495232-5-25-2023-30-CC-LCLN-CS6UFL-20230525153255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495232
Report Date: 05/25/2023
Date Signed: 05/25/2023 03:33:19 PM

Document Has Been Signed on 05/25/2023 03:33 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MOSS FAMILY CHILDCARE		FACILITY NUMBER:	197495232
ADMINISTRATOR:	DEBRA MOSS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 674-8424
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90044
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	05/25/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	DEBRA MOSS, APPLICANT		TIME COMPLETED:	04:00 PM

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On 05/25/2023 at 1:30pm Licensing Program Analyst (LPA) Lisa Clayton met with applicant for an ANNOUNCED PRE-LICENSING INSPECTION. LPA Clayton met applicant Debra Moss. There were no children in care. The home was toured with the applicant for a health and safety inspection. Hours of operation are Monday through Friday, 24 hours a day. Applicant will provide breakfast, lunch, dinner (as needed) and am/pm snacks.

This is a single-family, two story, home which consists of the following: 4 bedrooms, 3 full bathrooms, family room, living room/dining room, kitchen, fenced front and backyard, detached garage.

The applicant has requested the OFF-LIMIT AREAS are as follows: the entire second floor (bedrooms 1, 2 and 3, bathrooms 1 and 2, kitchen and the entire backyard, all of which will be inaccessible by child safety gates, closed and/or locked doors and visual supervision.

The Applicant has requested the following rooms be ON-LIMITS: bedroom #4 (day care room), bathroom #3, living room/dining room, kitchen, and family room (day care room), and the fenced front yard. The ISOLATION AREA will be in the living room and the children will nap in the day care room and the family room.

The home is neat and clean with heating and ventilation for safety and comfort. Per applicant, there are no firearms in the home. A copy of the mortgage was reviewed and shows control of property.

Any poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are inaccessible.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MOSS FAMILY CHILDCARE	FACILITY NUMBER: 197495232
	VISIT DATE: 05/25/2023

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The home has a fully charged 2A:10: BC Fire Extinguisher and 2 working smoke detector/ carbon monoxide detectors combo and working telephone. Applicant CPR/First Aid certificate is current and expires August 2023. The applicant’s Mandated Reporter Training requirement expires March 2024. The applicant is in compliance with the immunization law which pertains to day care providers.

LPA discussed the safe sleep regulations with applicant 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.

Safe Sleep Practices were discussed with the applicant. When putting infants down to nap or long periods of sleep, children must be placed on their backs, in a crib, on a firm mattress with nothing in the crib except for a fitted sheet over the mattress. The child must be physically monitored and documented every 15 minutes, check their temperature, color of skin, and breath.

LPA also informed applicant 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.

California Law requires Family Child Care Home applicants to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MOSS FAMILY CHILDCARE	FACILITY NUMBER: 197495232
	VISIT DATE: 05/25/2023

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The Applicant was informed 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 to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the applicants and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email: childcareadvocatesprogram@dss.ca.gov

Update on Incidental Medical Services (IMS):
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.
IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. Incidental Medical Services (IMS) policy was discussed. For further 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 with applicant the process of childcare during a pandemic: facial coverings in day care, social distancing, hand washing hygiene, postings, and cleaning and disinfecting of surfaces and high traffic areas. Children should follow social distancing when indoors. LPA Clayton discussed isolation area with applicant when children are sick. LPA discussed the importance and process of health screenings for children upon arrival to the facility. LPA also provided resources and materials as well as links for COVID-19 to assist the provider. LPA also discussed the proper way to clean and disinfect items used daily throughout the day care, by submerging toys in or spraying with disinfectant and allowing enough contact time prior to wiping down.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MOSS FAMILY CHILDCARE	FACILITY NUMBER: 197495232
	VISIT DATE: 05/25/2023

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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
· LIC 9927 Individual Infant Sleeping Plan
· LIC 995A Notification of Parent’s Rights
· LIC 613A Personal Rights
· Immunization Record

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 Property Owner/Landlord Consent Form
· 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 immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years.

FORMS TO BE POSTED

· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MOSS FAMILY CHILDCARE	FACILITY NUMBER: 197495232
	VISIT DATE: 05/25/2023

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In addition, LPA Clayton informed applicant of the following:

o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o 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.
o LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Applicant was reminded of Departments inspection authority, with or without any notice.

Based on today's inspection the following is required prior to issuing a license:

*Inspection of the 2^nd floor

Inspection of the 2^nd floor of the home is scheduled for 06/01/2023.

An exit interview was conducted, and a copy of this report was provided to applicant. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC809 (FAS) - (06/04)

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