<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495382
Report Date: 06/04/2024
Date Signed: 06/04/2024 12:53:38 PM

Document Has Been Signed on 06/04/2024 12:53 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:CHASE FAMILY CHILD CAREFACILITY NUMBER:
197495382
ADMINISTRATOR/
DIRECTOR:		BELINDA CHASEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 256-8753
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:BELINDA CHASE, APPLICANTTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 06/04/2024 Licensing Program Analyst (LPA) Lisa Clayton and LPA Tyra Chavies conducted an ANNOUNCED PRE-LICENSING INSPECTION with applicant Belinda Chase. There were no children in care.

Hours of operation are Monday – Friday 6am – 6pm. Families will provide all meals, applicant will provide occasional snacks, water and approved beverages.

The home was toured with the applicant for a health and safety inspection.

The facility sketch was reviewed, and LPA Clayton confirmed that the three-story condo home consists of the following: attached garage, office, living room/dining room, kitchen, 3 bedrooms, 3 full bathrooms, one ½ bath, laundry room (on the south side patio), patio on the southside and patio on the northside of the home. The home does not have a front or back yard.

The applicant has requested the following rooms be ON-LIMITS: the office (on the first floor), bathroom #1 (first floor), living room/dining room (main day care area) and bathroom #2. The ISOLATION AREA will be in the living room.

The applicant has requested the OFF-LIMIT AREAS are as follows: attached garage, the entire third floor (bedroom #1, bedroom #2, bedroom #3, bathroom #3 and bathroom #4) and both patios, all of which are made inaccessible to children in care by closed and/or locked doors and visual supervision.

The home is neat and clean with heating and ventilation for safety and comfort. The home has a working phone and LPA Clayton confirmed the number is 310-256-8753.

LPA Clayton observed two fully stocked First Aid Kits, a fully charged 2A:10B:C Fire Extinguisher in the kitchen and working smoke detector/carbon monoxide detector combo in the living room. A Fire Clearance was approved by the LA County Fire Department Prevention Bureau on 05/30/2024.


SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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 5
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: CHASE FAMILY CHILD CARE
FACILITY NUMBER: 197495382
VISIT DATE: 06/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Per Licensee, there are no firearms in the home. Any poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are inaccessible.

There are no pools, ponds or any other bodies of water on the premises.



LPA Clayton observed age-appropriate books and furnishing and equipment that are in good condition, free of sharp, loose or pointed parts.

The Applicant has current CPR/First Aid which expires August 2025 and Mandated Reporter Training certificate that expires May 2026. Applicant is in compliance with the immunization law which pertains to day care providers. LPA Clayton reminded applicant that the CPR/First Aid and Mandated Reporter training are to be updated every 2 years.

Applicant stated that she plans to provide care to children ages 2 ½ and up. LPA Clayton provided applicant with a copy of the safe sleep regulation, and advised applicant if needed, to access the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and­resources/safesleep as an additional resource. LPA Clayton informed applicant of the importance of checking for recalled infant devices on the United States Consumer Products 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 the purchased equipment.



LPA Clayton informed applicant that 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. Please report Telephone number changes and/or if you move from home.

Incidental Medical Services (IMS) policy was discussed, and LPA Clayton provided applicant with a sample IMS Plan for her reference. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: CHASE FAMILY CHILD CARE
FACILITY NUMBER: 197495382
VISIT DATE: 06/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Chavies 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 Chavies provided applicant with 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 995A Notification of Parent’s Rights
· Immunization Records

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
· 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: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: CHASE FAMILY CHILD CARE
FACILITY NUMBER: 197495382
VISIT DATE: 06/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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.

The applicant is reminded any structural changes to the home, additions to the home or making a previously off limit area accessible to children in care, must be reported to Community Care Licensing.

Applicant was advised of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.



Applicant 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.

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

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: CHASE FAMILY CHILD CARE
FACILITY NUMBER: 197495382
VISIT DATE: 06/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During the exit interview, applicant Belinda confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Prior to licensing, the applicant will make the following corrections on or before Monday June 17, 2024.
· Gate at the bottom of the stairs
· Move parent board
· Lock on bathroom #1 cabinet
· Cushion or mat under playplace
· Screen and child safety gate on patio door
· Screen on the air conditioner
· Mats/cots for sleeping

An exit interview was conducted, and report was reviewed and provided to applicant Belinda Chase. 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: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5