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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495411
Report Date: 08/15/2024
Date Signed: 08/16/2024 08:47:31 AM

Document Has Been Signed on 08/16/2024 08:47 AM - 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:LEWIS FAMILY CHILD CAREFACILITY NUMBER:
197495411
ADMINISTRATOR/
DIRECTOR:		BIANCA LEWISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 300-5167
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:12 AM
MET WITH:Bianca Lewis
TIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On 08/15/2024 Licensing Program Analyst (LPA) Ranita Richmond conducted an ANNOUNCED PRE-LICENSING INSPECTION with applicant Bianca Lewis. Hours of operation are Monday – Friday 6:00am – 6:00pm. Applicant is open to provide overnight care and weekend care as needed. Applicant will provide meals, snacks, and approved beverages.

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

LPA confirmed that the single story home consists of the following: living room, kitchen, laundry room, 4 bedrooms, 2 full bathrooms, and gated back yard.

The applicant has requested the following rooms be ON-LIMITS: the living room (main day care area, daycare eating/napping area), bathroom #1, bedroom #2 (recreation area), bedroom #3 (recreation room), and gated back yard. The ISOLATION AREA will be in the bedroom #2.

The applicant has requested the OFF-LIMIT AREAS are as follows: (bedroom #1, bedroom #4, bathroom #2, and kitchen, all of which are made inaccessible to children in care by child safety gates, 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 Richmond confirmed the number is 323-696-9333.

The home has a working smoke detectors throughout the home, carbon monoxide detectors in the hallway of the home and a fully charged 2A10BC Fire Extinguisher in the kitchen. LPA Richmond observed a fully stocked First Aid Kit in the kitchen.



There is no firearms or ammunition in the home.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 197495411
VISIT DATE: 08/15/2024
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Parents will enter the home through the front door. The home is shaped vertically. When entering the home you are in the living room. Facing left in the living room you will be able to walk completely through the home. At the end of the living room to the left is bedroom #1 (off limits), nest to bedroom #1 on the left is the kitchen (off limits), across from the kitchen on the right is bed room #2 (on limits), next to bedroom #2 on the right is bathroom #1 (on limits), across from bathroom on the left is bedroom #3 (on limits), at the end of the hallway is bedroom #4 (off limits), inside bedroom #4 is bathroom #2 and laundry room, (off limits). There is also access to the gated back yard(on limits) through bedroom #4. Children and parents can access the gated backyard through walking up the driveway of the home and entering through a gate.

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

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-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.



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. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) 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: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 197495411
VISIT DATE: 08/15/2024
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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 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 9927 Individual Infant Sleeping Plan
· Infant Sleep Log
· 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: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 197495411
VISIT DATE: 08/15/2024
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In addition, LPA Richmond 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 confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Prior to licensing, applicant will make the following corrections, on or before 08/29/2024:
· Gate in backyard to clearly define outdoor play area.


An exit interview was conducted, and report was reviewed and provided to Bianca Lewis.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC809 (FAS) - (06/04)
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