198003839-3-24-2023-54-CC-WBIS-CQ8VHH-20230324162709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198003839
Report Date: 03/24/2023
Date Signed: 03/24/2023 04:27:23 PM

Document Has Been Signed on 03/24/2023 04:27 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 CARE		FACILITY NUMBER:	198003839
ADMINISTRATOR:	COOK, SHARON & ANNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 489-6029
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	03/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:44 PM
MET WITH:	Anne Cook		TIME COMPLETED:	04:30 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	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 four infant children. There are four 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. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed toys and play equipment appear to be age appropriate. However, LPA observed one crib and two low-ground bassinets type napping equipment. LPA informed the Licensee that Title 22 requires one crib or play yard for every infant that is unable to climb out. 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. 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, and a tortoise that remain inaccessible to children (in other rooms). LPA also observed 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 on file. 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: 03/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

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 4

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: 03/24/2023

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, 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 31, 2023. LPA observed the required 2A 10BC fire extinguisher's annual service is due June 2023. The Licensee's Mandated Reporter training is expires in June 16, 2023. The Licensees have Measles and Pertussis documentation on file.

LPA reviewed four 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, 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. The department doesn't recommend trampolines.

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: 03/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 03/24/2023

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

The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP. 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. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in 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. Licensee has the required current Mandated Reporter training.

LPA informed Licensee information regarding with Safe Sleep PIN 20-24-CCP and provided Licensee with Title 22 printout of infant safe sleep. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided.

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: 03/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 03/24/2023 04:27 PM - It Cannot Be Edited

Created By: Warren Birks On 03/24/2023 at 03:33 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: COOK FAMILY CHILD CARE	FACILITY NUMBER: 198003839
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(a)(1)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (1) All cribs or play yards shall meet the United States Consumer Product Safety Commission safety standards. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above: LPA observed Licensee's two of three infant napping equipment to not meet CDSS Title 22 standards. LPA observed low ground bassinets which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/27/2023
	Plan of Correction
1 2 3 4	Licensee indicated she will provide evidence of infant play yards.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Karen Chambers

LICENSING EVALUATOR NAME:

Warren Birks

LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4