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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000739
Report Date: 01/13/2022
Date Signed: 01/14/2022 11:08:33 AM

Document Has Been Signed on 01/14/2022 11:08 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MILLER, BETTY FAMILY DAY CAREFACILITY NUMBER:
198000739
ADMINISTRATOR:MILLER, BETTYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 532-0547
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
01/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Betty Miller, LicenseeTIME COMPLETED:
03:37 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. LPA met with Betty Miller, Licensee. LPA explained the purpose of the inspection. LPA provided licensee with and explained the inspection Entrance Checklist, LIC 126, and requested that the items on the sheet be made available for inspection. Licensee provided tour of facility. LPA inspected rooms/areas on the facility sketch in which child care services are provided and to which children have access. Per licensee the hours of operation are Monday-Friday 7:00am-6:00pm.

This is a single story, 3 bedroom/1 bath home. The main childcare areas are the living room and two (2) bedrooms. Children use the restroom at the end of the hallway. All adults present during this inspection have obtained a background clearance.


Off limit areas include Licensee's bedroom, the detached garage at the front of the home, the front yard and locked shed in the back yard. Licensee's bedroom was observed to be locked.

Individuals residing in the home were discussed and noted.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA observed required posted documentation in facility entrance which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. Disaster drill log 12/13/2021.



Page 1 – Report Continues
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2022
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 6
Document Has Been Signed on 01/14/2022 11:08 AM - It Cannot Be Edited


Created By: Alicia Mooberry On 01/13/2022 at 05:23 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MILLER, BETTY FAMILY DAY CARE
FACILITY NUMBER: 198000739

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above based on Child #1, an infant under 12 months of age was missing the LIC 9227 in the file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2022
Plan of Correction
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Per licensee, a completed LIC 9227 Infant Sleep Plan will be sent to the Department via email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2022


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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MILLER, BETTY FAMILY DAY CARE
FACILITY NUMBER: 198000739
VISIT DATE: 01/13/2022
NARRATIVE
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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced 02/2021, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone and land line. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds are stored in locked cabinets in the kitchen area, inaccessible to children.

Licensee states that there are no poisons stored in the home and understands that all poisons must be locked and inaccessible to children in care. Isolation area for sick children waiting to be picked up is in living room, away from the other children. Per licensee there are no firearms or weapons stored in the home. There are no pets in the home.

The wall heater has a tall barrier that is bolted to the wall.

The bathroom that children use is located at the end of the hallway and is observed to be clean and free of hazards.



Infant Care: Currently licensee has one (1) infant under 12 months enrolled. LPA informed licensee of the new Safe sleep regulations, and reviewed and provided PIN 20-24-CCP and LIC 9227 Infant Sleep Plan for infants 12 months and under, LPA explained the 15-minute sleep check documentation required for infants 0-24 months. Licensee states that infants are supervised by Licensee or assistant at all times during nap time. Per licensee, the door to the infant nap room is always maintained open.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months). During record review at 12:15pm LPA observed LIC 9227 is not in Child #1's file, additionally, Child #2 infant of 17 months did not have a file available. This poses a potential risk to the health and safety of children in care.


The children use the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. Facility does not have bodies of water on the premises.

Page 2 - Report Cont.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MILLER, BETTY FAMILY DAY CARE
FACILITY NUMBER: 198000739
VISIT DATE: 01/13/2022
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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.

LPA also informed licensee 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.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

Due to LPA having technical issues this report was completed on 1/14/22 at 10:39am.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Betty Miller.




Page 4 - End of report
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 01/14/2022 11:08 AM - It Cannot Be Edited


Created By: Alicia Mooberry On 01/13/2022 at 05:23 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MILLER, BETTY FAMILY DAY CARE
FACILITY NUMBER: 198000739

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above due to Staff #1 did not have the required immunizations on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/21/2022
Plan of Correction
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Per licensee, Staff will no longer work at facility. The last day is 1/14/22. Licensee will ensure that all new emplyees have they immunizations prior to stating emplyment, A written staemnet was obrained from licensee.
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 6 files were not available. Child #2 was missing file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2022
Plan of Correction
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Per licensee, a copy of Child #2's facility file will be sent to department via email py POC due date. Licensee has provided a written declaration stating they will insure all children receiving care at the above faciltiy will have a complete faciltiy file prior to attending facility.
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2022


LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MILLER, BETTY FAMILY DAY CARE
FACILITY NUMBER: 198000739
VISIT DATE: 01/13/2022
NARRATIVE
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Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

Staff record review indicate that Staff #2 is missing their immunization including MMR, Tdap and Influenza, This poses a potential risk to the health and safety of children in care.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

COVID-19: LPA observed that licensee is implementing COVID-19 precautions and procedures. LPA provided licensee with hand washing signs for the bathroom and kitchen. The licensee conducts wellness checks upon entry for children and staff. Isolation area for children who are ill is in the living room area by the front door.

Incidental Medical Services (IMS) policy was discussed. For 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.


Page 3 - Report Cont.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC809 (FAS) - (06/04)
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