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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495289
Report Date: 02/26/2025
Date Signed: 02/27/2025 04:50:32 PM

Document Has Been Signed on 02/27/2025 04:50 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:TURBI-FAMILIA & BOSTICK FAMILY CHILD CAREFACILITY NUMBER:
197495289
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
02/26/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:24 AM
MET WITH:R. BostickTIME VISIT/
INSPECTION COMPLETED:
11:29 AM
NARRATIVE
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On 2/26/25 Licensing Program Analyst (LPA) Ranita Richmond arrived at the above named home to conduct an unannounced Case Management Deficiencies visit. LPA was met by licensees R. Bostick and W. Turbi-Familia. LPA observed 2 children in care being supervised by licensees.

LPA toured the home for health and safety. During tour LPA observed a play yard with loose items inside, including a pillow and blanket. Type B citation issued. See LIC 809D.

LPA requested file for infant child(C1) and observed LIC 9227 missing for child in care. Type B citation issued. See LIC 809D.

LPA observed no infant sleep chart completed for C1. Type B citation issued. See LIC 809D.

LPA reviewed infant safe sleep with licensee. LPA provided licensee with LIC 9227 and infant sleep log.

LPA provided applicant with the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA Richmond gave applicant a packet of all required forms, and posters and reviewed following forms:

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
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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TURBI-FAMILIA & BOSTICK FAMILY CHILD CARE
FACILITY NUMBER: 197495289
VISIT DATE: 02/26/2025
NARRATIVE
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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

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, citations were cited today. See LIC 809D.
Exit interview conducted, and report was reviewed with R. Bostick
Appeal rights printed and reviewed with licensee R. Bostick.
A Notice of Site Visit was provided and must remain posted for 30 days.


page 2 of 2
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/27/2025 04:50 PM - It Cannot Be Edited


Created By: Ranita Richmond On 02/26/2025 at 12:54 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: TURBI-FAMILIA & BOSTICK FAMILY CHILD CARE
FACILITY NUMBER: 197495289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2025
Section Cited
CCR
102425(b)

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102425 Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
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Licensee will ensure that play yards are free from loose articles and objects at all times. Licensee will remove all loose articles and objects from play yard.
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LPA observed loose items in play yard such as pillows and blankets.
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Type B
03/12/2025
Section Cited
CCR102425(c)

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102425 Infant Safe Sleep
(c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age... and maintained at the facility in the infant’s file.
This requirement is not met as evidenced by:
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Licensee will complete and provide LIC 9227 to C1 authorized representative for completion. Licensee will file LIC 9227 for C1 upon completion.
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LPA reviewed file for C1. LIC 9227 is not present in file for C1
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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/27/2025 04:50 PM - It Cannot Be Edited


Created By: Ranita Richmond On 02/26/2025 at 01:02 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: TURBI-FAMILIA & BOSTICK FAMILY CHILD CARE
FACILITY NUMBER: 197495289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2025
Section Cited
CCR
102425(j)(2)

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102425 Infant Safe Sleep
(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (2) The provider shall check and document the following:
This requirement is not met as evidenced by:
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Licensee will complete and keep on file for Department review an infant sleep chart for all infants 24 months of age and under in care. Licensee will document the infant sleep chart as needed.
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LPA observed infant sleep chart missing for C1.
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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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