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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003839
Report Date: 04/21/2022
Date Signed: 04/21/2022 02:26:48 PM

Document Has Been Signed on 04/21/2022 02:26 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:COOK FAMILY CHILD CAREFACILITY NUMBER:
198003839
ADMINISTRATOR:COOK, SHARON & ANNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 489-6029
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Anne CookTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required 1 Year inspection. LPA met with Licensee Anne Cook who guided LPA on a tour of the facility. LPA observed the Licensee caring for two infant children. There are three children enrolled attending the facility on a full-time basis. The Licensee cares for infants only at this time. The residents of the home were notated.

All areas identified on the facility sketch were inspected. This is a single story home consisting of four bedrooms, two bathrooms, kitchen, living room, two side yards, back yard, and garage. The Licensee provides care in the Master bedroom (converted to a daycare space) and the enclosed side yard. Areas off limits to children in parents include all other bedrooms and the rest of the house. At 12:30pm LPA provided Licensee with Items not permitted, PIN 20-24-CCP Infant Safe and a form regarding capacity/ratio.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. At 12:15pm LPA observed toys and play equipment appear to be age appropriate. LPA observed the off limit rooms inaccessible by a baby gates in the hallway. There is was no accessible fire place observed in the home and the garage is inaccessible. Around 12:30pm LPA observed a side yard used for the outdoor play which appears to be safe and free of hazards at this time. There is a large locked gate over 5 ft that separates the side yard from the back yard. The garage is off limits and remains inaccessible. There is a working telephone maintained in the home. There are two little dogs, four cats, a rabbit and a tortoise that remain inaccessible to children (in other rooms). LPA observed a pet bird in the daycare area and various pet arachnids. Licensee indicated that the pet arachnids are not harmful and remain in containers at all times (unless for display for child's benefit and knowledge). The Licensee has signed acknowledgements from parents regarding pets. LPA observed Detergents, cleaning compounds, medications, and other items which can pose a danger to children to be inaccessible (daycare is barricaded with baby gates and items are placed in high areas where infants cannot get to them). LPA informed Licensee that poisons must be locked with a key or combination lock.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: COOK FAMILY CHILD CARE
FACILITY NUMBER: 198003839
VISIT DATE: 04/21/2022
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Per Licensee there are no firearms, weapons or bodies of water on the premises (and LPA did not observe any). LPA observed the License, Earthquake Preparedness form and the Parents Rights poster posted in the facility. The children's roster and Disaster drill is current (last date of drill October 18, 2021. LPA observed the required 2A 10BC fire extinguisher's annual service is due June 2022. The Licensee's Mandated Reporter training is expires in June 16, 2023. The Licensees have Measles and Pertussis documentation on file.

At 1:15pm LPA reviewed two children's files and observed files to be complete. The files included items such as Parent's Rights, Affidavit for Liability Insurance, Identification and Emergency, Consent for Emergency Treatment, Immunization records, and LIC 9227 Safe Sleep documents for infants under 12 months.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

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.

LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
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: COOK FAMILY CHILD CARE
FACILITY NUMBER: 198003839
VISIT DATE: 04/21/2022
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The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility and staff's to know the regulations when providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com.

LPA provided Licensee with Safe Sleep PIN 20-24-CCP also discussed Covid Self Assessment and Covid safety according to the Los Angeles County Health Department.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Anne Cook
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC809 (FAS) - (06/04)
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