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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006584
Report Date: 06/11/2024
Date Signed: 06/11/2024 11:41:54 AM

Document Has Been Signed on 06/11/2024 11:41 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:NICKLES-WEEMES FAMILY DAY CAREFACILITY NUMBER:
198006584
ADMINISTRATOR/
DIRECTOR:		NICKLES,SHEYRLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 808-9213
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 2DATE:
06/11/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:NICKLES,SHEYRL / LICENSEETIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced annual required inspection at the above facility. LPA met with Licensee Sheryrl Nickles-Weemes who granted LPA entry.There were 3 children present during today's inspection. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon-Fri 7:00 AM - 6:00PM.

This is a two-story home which consists of 5 bedrooms, 2 bathrooms, kitchen, dining room, living room, front yard, backyard (fenced), and play room (converted garage). There is a fireplace in the living room, however, it was observed to be covered and barricaded. The children use the downstairs bathroom. Per licensee, areas off limits to children and parents include: 2 bedrooms upstairs and 1 restroom upstairs. The children and use: 2 bedrooms downstairs (multipurpose rooms for children in care), 1 bathroom, kitchen, dining room, backyard (fenced), and play room (converted garage). LPA advised Licensee sleeping and eating is prohibited in the playroom-garage.

Individuals residing in the home have been 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 reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 2/09/24. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 11/13/2023, inspections are done yearly. The home maintains telephone service via cell phone and landline. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children inside and outside of the home. (Page 1, Continuation 809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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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Document Has Been Signed on 06/11/2024 11:41 AM - It Cannot Be Edited


Created By: Ashley Calderon On 06/11/2024 at 10:18 AM
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: NICKLES-WEEMES FAMILY DAY CARE
FACILITY NUMBER: 198006584

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon's observation during record review Staff #2 did not have LIC9052 in file, licensee during interview stated needs to provide that form to staff for records, the licensee did not comply with the section cited above in [1] out of [1] person which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2024
Plan of Correction
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LPA provided Licensee LIC9052 docuemantion name and Facility entrance checklist with required documentation's for employee. Per Licensee will provide form to staff and will email LPA Calderon copy of Employee Rights by POC due date.
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 LPA Calderon observation during record review Staff #2 is missing measles (MMR) and influenza records, Per Licensee interview will request missing immunization's, the licensee did not comply with the section cited above in [1] out of [1] person which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2024
Plan of Correction
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LPA provided Licensee with Facility entrance checklist with required immunization list documentation's for employee. Per Licensee will notify Staff #2 of immunization's to obtain and provide to licensee for completion of staff records, Licensee will email copy of immunization's to LPA emails by POC due date.
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:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NICKLES-WEEMES FAMILY DAY CARE
FACILITY NUMBER: 198006584
VISIT DATE: 06/11/2024
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LPA observed that detergents, cleaning compounds, sharps and medication are inaccessible to children. Licensee understands that all poisons must be locked, per licensee no poisons stored in the home. Per Licensee there are no firearms or weapons stored in the home. Per Licensee, no children on medication. Per Licensee, provides children with food, LPA informed Licensee any food provided by parents should be labeled and sealed and stored correctly. LPA observed a baby gate placed at the bottom of the staircase to prevent children from accessing the second floor-off limit area.

At this time, Licensee does not have any infants enrolled , LPA reviewed with Licensee sleep regulations , and requirements and documentation(s) needed for Infants: Sleep Log (sample was provided) and LIC9227 Indiv. Infant Sleep Plan. LPA reviewed the following in case Licensee decides to care for infants in the future: napping equipment cannot block entrances or exits. Cribs or play pens cannot have loose object, bumpers, objects hanging, or objects attached to the play yards. No walkers or similar infant objects. LPA observed infants cribs and bedding in the multipurpose bedroom. Per Licensee does not provide any overnight care at this time. Per Licensee, no pets remain in the home.

Currently, children are using 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. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water, Licensee was advised if any plans to have bodies of water to call Licensing before changes.



Children’s records were reviewed (5) children files had immunization and identification and emergency records in place, LPA advised to add LIC9150 to files. LPA reviewed licensee and assistant staff records. Per record review, Staff #2 is missing Measles (MMR) and Influenza shot record or exemption letter and employee rights LIC9052, deficiencies cited for missing records. Per Licensee, assistant does not stay alone with children. Licensee records were reviewed and CPR/First Aid Exp. 9/13/25 and Mandated Report Training Expires 1/27/26.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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 2, continuation 809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NICKLES-WEEMES FAMILY DAY CARE
FACILITY NUMBER: 198006584
VISIT DATE: 06/11/2024
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Licensee 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.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Based on today’s visit, Per California Code of Regulations Title 22, the facility was given deficiencies provided on LIC 809-D.

A notice of site visit was given and must remain posted for 30 days and appeal rights provided. Exit interview conducted and report was reviewed with the licensee and was provided to Licensee Sheyrl Nickles Weemes
(Page 3. End of Report)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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