198008186-9-15-2023-54-CC-DCHS-CVPUXJ-20230915155825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198008186
Report Date: 09/15/2023
Date Signed: 09/15/2023 03:58:38 PM

Document Has Been Signed on 09/15/2023 03:58 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:	WILLIS FAMILY CHILD CARE		FACILITY NUMBER:	198008186
ADMINISTRATOR:	WILLIS, LOLITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 208-5054
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90804
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	09/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Lolita Willis, Licensee		TIME COMPLETED:	04:15 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	On September 15, 2023, at 12:45pm, Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced inspection to the above facility. LPA arrived at the facility at 12:45pm identified self and met with Licensee, Lolita Wilis who guided analyst on a tour of the facility. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. LPA observed 2 children upon arrival. A current children’s roster was available for review. Per Licensee, operation hours Monday through Friday 6:00AM to 5:00Pm. There are 17 children that are currently enrolled. A current children’s roster was available for review. There were 2 children present upon arrival. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, laundry room, living room, front yard, and backyard (fenced) and attached garage which is converted into an activity room. In the backyard, LPA observed an apartment unit that has the same address. The children use the bathroom in the hallway near the bedrooms. Per Licensee, areas off limits to children and parents include: 3 bedrooms, 1 bathroom, living room, and backyard unit. The licensee provides food for children in care. Individuals who reside in the home were noted and discussed. Per Licensee, they currently have two assistants. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in the licensed childcare home. Licensee states that there are no firearms stored in the home. Per licensee, there are no pets on the premises. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via cellphone and the cellphone stays at the facility during operation hours. There is ventilation and heating via central heat and air conditioning. Safe toys play equipment and materials were observed. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary. At approximately 3:20pm, LPA observed the receipt for the fire extinguisher was expired on 09/06/2022. The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors were tested and are operable.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

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 09/15/2023 03:58 PM - It Cannot Be Edited

Created By: Dayna Chambers On 09/15/2023 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: WILLIS FAMILY CHILD CARE	FACILITY NUMBER: 198008186
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, Fire Extinguisher was not annually serviced. The receipt was dated 09/062022 and is expired on 09/06/23, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/25/2023
	Plan of Correction
1 2 3 4	Licensee will purchase a new fire extinguisher and email proof of correction by email to LPA by 09/25/23.

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
1 2 3 4	Based on observation and record review, the mandated reporter for licensee expired on 10/08/2022, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/25/2023
	Plan of Correction
1 2 3 4	Licensee will renew the mandated reporter by 09/25/23 and send proof of completion to LPA by email.

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:

Dayna Chambers

LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 7

Document Has Been Signed on 09/15/2023 03:58 PM - It Cannot Be Edited

Created By: Dayna Chambers On 09/15/2023 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: WILLIS FAMILY CHILD CARE	FACILITY NUMBER: 198008186
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee's EMSA Pediatric First Aid and CPR was expired on 06/02/2023, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/25/2023
	Plan of Correction
1 2 3 4	Licensee will renew the EMSA Pediatric First Aid and CPR by 09/25/23 and send proof of correction to LPA by email

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Dayna Chambers

LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: WILLIS FAMILY CHILD CARE	FACILITY NUMBER: 198008186
	VISIT DATE: 09/15/2023

NARRATIVE

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Licensee states that she is currently caring for infants 12 months to 24 months. The infants are able to climb and walk. Licensee states that infants sleep in the activity room where they are constantly supervised. The current infants are sleeping in cots because they climb. Appropriate sleeping arrangements were observed. The placement of the cots did not hinder the entrance or exit from the sleeping space. LPA did not observe any infants swaddled while in care. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. A copy of the LIC 9227 was provided to Licensee. a copy of the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect. Currently, children are using the back yard for outdoor play time. 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 can pose a danger to children on the outdoor yard. The licensee is observed to be operating within the license capacity limitations. The personnel have completed training on preventive health practices including Pediatric First Aid and CPR. At approximately 2:30pm, during record review, LPA observed the licensee's Pediatric First Aid and CPR expired on 06/05/2023. There are first aid supplies available. LPA advised that if a child shows signs of illness, he/she/they shall be separated from other children. Children’s records were reviewed, including emergency information, and were observed to be complete. The licensee does have proof of immunizations against MMR, TDAP, TB Clearance, and declination of influenza. At approximately 2:45pm, LPA observed that the assistants do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.
LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 09/14/2023. There are no pets on the premises. LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family childcare facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. LPA Provided Infant Safe Sleep Resources and Immunization Resources. 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.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: WILLIS FAMILY CHILD CARE	FACILITY NUMBER: 198008186
	VISIT DATE: 09/15/2023

NARRATIVE

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Licensee [or facility representative] 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 [or facility representative] 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. LPA also informed licensee [or facility representative] 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 [or facility representative] was informed of the MyChildCarePlan.org website: a consumer education website that helps families obtain childcare by connecting them to childcare 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Lolita Willis.
The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22.
Title 22, Division 12, Chapter 1, Article 06. Continuing Requirements
10417(g)(1), Operation of a Family Child Care Home (Expired on 09/06/2022) Fire Extinguisher)
Title 22, Division 6, Health and Safety Code, Chapter 3.4 California Child Day Care Act, Article 02. Administration of Child Day Care Licensing,
1596.8662 (mandated reporter expired 10/08/2022)
Title 22, Division 12, Chapter 1, Article 06. Continuing Requirements
102416(c) Personnel Requirements (EMSA Pediatric First Aid and CPR) expired 06/05/23

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC809 (FAS) - (06/04)

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