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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009281
Report Date: 06/02/2023
Date Signed: 06/02/2023 04:05:54 PM

Document Has Been Signed on 06/02/2023 04:05 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:HOFFMAN FAMILY CHILD CAREFACILITY NUMBER:
198009281
ADMINISTRATOR:HOFFMAN, SOCORROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 440-0586
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
06/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Socorro Hoffman, Licensee TIME COMPLETED:
04:20 PM
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On 06/02/2023 at 2:00 PM, Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Socorro Hoffman, who granted entry to facility and guided the LPA on a tour. Adults in the home were discussed and all have criminal record clearance. There were five day care children (one infant) present during today’s inspection. Two additional children arrived during inspection, census totaling seven children. Licensee states that there are currently 12 children enrolled. The children's roster was reviewed and is current. Required postings were observed at time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 02/2023.

This is a single-sotry home which consists of three bedrooms and two bathrooms, Kitchen, Dining Room, and Living Room. Areas used by the children include the Living Room (located upon entry of the home), Bedroom 1 (located to right upon entrance), Dining Room (located next to Living Room), and Bathroom 1 (located to the right of Kitchen). Per Licensee, areas off limits to children and parents include Kitchen, Bedrooms 2 & 3, and Bathroom 2 that is inside Bedroom 2. LPA observed Dining Room entrance blocked at time of inspection making these areas off limits to children in care.

All areas identified on the facility sketch as 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 fireplace and wall heater in facility that has been made off limits to children in care. There is a working telephone maintained in the home. At 2:05 PM, LPA observed Bedroom 1, that Licensee states is used for sleep, to have two beds and a crib for infant sleep. LPA observed additional sleep equipment (blue cots) in Dining Room used for sleep. At 2:08 PM, LPA observed Living Room to have couch, infant play area, and shelves filled with various toys and play equipment for children. At 2:10 PM, LPA observed Bathroom 1 to have operable toilet and
Report Continues - Page 1 of 4
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HOFFMAN FAMILY CHILD CARE
FACILITY NUMBER: 198009281
VISIT DATE: 06/02/2023
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sink, and adequate hand washing and toileting supplies at time of inspection. LPA discussed observations in under cabinet sink and medicine cabinet at time of inspection. Detergents, cleaning compounds,
medications, and other items which can pose a danger to children are inaccessible. At 2:12 PM, LPA observed these items to be stored in off limits Kitchen in high cabinets and shelves at time of inspection. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

Per Licensee, the children will have access to front yard for outdoor play. At 2:15 PM, LPA observed front yard has adequate perimeter fencing through-out the yard. LPA observed left side of yard fenced off for play area. LPA observed various plastic play equipment, slide, playhouses, and other age appropriate toys available for the children. LPA observed play equipment to have spider webs on them, visible dirt, and garbage on the floor of play area. Licensee acknowledges the disarray of play area and Licensee states she has been out of town and that children have not used play area for over two weeks. Licensee states she has two large dogs that are kept separate in the backyard and are kept separate when children are in care.

Per Licensee, they provide food for children in care and use either Living Room or Dining Room to eat.

At 2:12 PM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with proof of purchase receipt on 07/03/2022. LPA tested dual smoke and carbon monoxide detectors and observed to be in operable condition at time of inspection. LPA observed First Aid kit kept in Living Room and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR valid until 06/25/2024. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. Per Licensee, she has taken AB1207 Mandated Reporter training but did not have proof of completion at time of inspection.
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or any weapons/firearms at time of inspection. Per Licensee, isolation area for sick children will be in area of home currently not being used.
Report Continues - Page 2 of 4
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HOFFMAN FAMILY CHILD CARE
FACILITY NUMBER: 198009281
VISIT DATE: 06/02/2023
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The following were discussed:
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

Licensee (or facility representative) was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are 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.



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.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/
Report Continues - Page 3 of 4

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HOFFMAN FAMILY CHILD CARE
FACILITY NUMBER: 198009281
VISIT DATE: 06/02/2023
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Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.


Exit interview was conducted and report was reviewed with the Licensee, Socorro Hoffman.


Report Ends - Page 4 of 4
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/02/2023 04:05 PM - It Cannot Be Edited


Created By: Katrina Chicote On 06/02/2023 at 03:45 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: HOFFMAN FAMILY CHILD CARE
FACILITY NUMBER: 198009281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and interview, Licensee did not meet above requirement. Licensee states she understands the current state of facility. LPA observed excessive clutter, items stacked haphazardly unable to view contents, spider webs and visible dirt on outside play equipment and other areas used by the children at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 07/03/2023
Plan of Correction
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Licensee states she will organize and clean areas of home discussed and provide photo proof to LPA by POC date via text/email.
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 LPA record review, Licensee did not have proof of completion of AB1207 Mandated Reporter training at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 07/03/2023
Plan of Correction
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Licensee states she will obtain copy of AB1207 and provide to LPA by POC date via text/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:Karen Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/02/2023 04:05 PM - It Cannot Be Edited


Created By: Katrina Chicote On 06/02/2023 at 03:45 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: HOFFMAN FAMILY CHILD CARE
FACILITY NUMBER: 198009281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Licensee did not have Emergency ID (LIC 700) for four of five children files (Child# 1, 2, 4, and 5) at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 07/03/2023
Plan of Correction
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Licensee states she will obtain records and provide photo proof via text/email to LPA by POC date.
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:Karen Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023


LIC809 (FAS) - (06/04)
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