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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008133
Report Date: 06/12/2024
Date Signed: 06/12/2024 04:43:37 PM

Document Has Been Signed on 06/12/2024 04:43 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BUCKLEY FAMILY CHILD CAREFACILITY NUMBER:
198008133
ADMINISTRATOR/
DIRECTOR:		BUCKLEY, TAMARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 716-9665
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Licensee, Tamara BuckleyTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On June 12, 2024 Licensing Program Analyst (LPAs) Jonnisha Culbert and Jeanette Estrada conducted an unannounced inspection at the facility noted above and met with Licensee, Tamara Buckley. The purpose of the inspection was to conduct the Annual/Random inspection. The operating hours of the facility are Monday through Friday from 8:00 AM to 6:00 PM. Licensee provides service to children ages 0 to 5 years old. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, Licensee, Licensee's Assistant and 10 children were present.

This facility is a single family home that consists of three (3) bedrooms, two (2) bathrooms, dining room, living room, family room, detached garage, and fenced backyard.

Areas that are accessible to children include: the family room, 1 bathroom, living room, dining room, and backyard (fenced). Per Licensee, the children utilize the backyard (fenced) for outdoor activity.

Areas off-limits to children include: 3 bedrooms, 1 bathroom, and detached garage. LPAs observed a door in between the dining room and family room (Daycare room). LPAs also observed child safety knobs installed on the gates located in the backyard. Per Licensee, children are dropped off and picked up from the side of the house and enter the family room (day care area) through the sliding door. The Licensee was advised that off-limit areas must be made inaccessible during operating hours.

The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), The Earthquake Preparedness (LIC 9148), Emergency Disaster Plan (LIC 610A), and a Disaster and Fire Drill log. The last Disaster and Fire Drill was conducted on May 24,2024..
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BUCKLEY FAMILY CHILD CARE
FACILITY NUMBER: 198008133
VISIT DATE: 06/12/2024
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Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. LPAs did not observe any wall heaters in the facility. The facility has central air and heating. The home has a fireplace located in the living room with a secure screen. Detergents, cleaning compounds and medicines were made inaccessible to children in care. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock in an inaccessible area.

Per Licensee, there are no pets, firearms, weapons or bodies of water on the premises. LPAs observed age appropriate toys and napping equipment for children. LPAs observed electrical outlet covers installed in the child care area. LPAs observed the required fire extinguisher (2A-10BC) that is fully charged and was purchased on August 9,2023. Fire extinguisher is located on the wall near on limits restroom accessible to children in care. Licensee was reminded to have the fire extinguisher serviced yearly. The combination smoke/ carbon monoxide detector was operable and located in the kitchen.

Licensee stated that she provides breakfast, lunch, and snacks to children. Per Licensee, children do not bring food from home. Licensee was informed that if food is brought from the child's home it shall be labeled with the child’s name and properly stored or refrigerated. LPAs observed knives on kitchen counter. Per Licensee children never walk through or go into the kitchen.

LPAs conducted a record review of 5 children's files, Licensee's file, and 1 staff (S1) file. Based on the file reviews, the children's records were complete and contained all of the required documents per Title 22 regulations, including documentation for the 15 minute physical checks for sleeping infants. Based on the file review, Staff records were complete but missing a valid Mandated Reporter Training. This poses a potential risk to the health and safety of children in care.

Licensee has current Pediatric First Aid and CPR certification, but it is not issued by American red Cross, American Heart Association or EMSA approved. LPAs advised Licensee to obtain Pediatric First Aid and CPR certification that meets title 22 requirements by July 12, 2024. Licensee has proof of current mandated reporter training that expires 07/20/24. Licensee has proof of immunization against measles and pertussis. Licensee has documentation of declination for influenza on record. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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: BUCKLEY FAMILY CHILD CARE
FACILITY NUMBER: 198008133
VISIT DATE: 06/12/2024
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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.

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.

LPAs 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-andresources/safe-sleep as an additional resource. LPAs 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 Tamara Buckley was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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: BUCKLEY FAMILY CHILD CARE
FACILITY NUMBER: 198008133
VISIT DATE: 06/12/2024
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During the exit interview,Tamara Buckley, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A type B citation is being issued

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

Exit interview conducted and report was reviewed with the licensee, Tamara Buckley.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/12/2024 04:43 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 06/12/2024 at 04:05 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: BUCKLEY FAMILY CHILD CARE
FACILITY NUMBER: 198008133

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews, the licensee did not comply with the section cited above in 1 out of 2 persons are missing a valid Mandated Reporter Training which poses a potential health and safety risk to persons in care.
POC Due Date: 06/26/2024
Plan of Correction
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Staff will complete Mandated Reporter Training and submit ceritfication by June 26, 2024.
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:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


LIC809 (FAS) - (06/04)
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