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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012887
Report Date: 10/18/2024
Date Signed: 10/21/2024 07:28:52 AM

Document Has Been Signed on 10/21/2024 07:28 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:HODGE FAMILY CHILD CAREFACILITY NUMBER:
198012887
ADMINISTRATOR/
DIRECTOR:		HODGE, EBONYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 500-8060
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH: Licensee Ebony HodgeTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On October 18, 2024 at 10:00a.m., Licensing Program Analysts (LPAs) Keneisha Dunlap and Dayna Chambers arrived at the above facility for the purpose of an unannounced Annual Inspection. LPA Dunlap announced the purpose of the visit and was granted entry into the facility by Licensee Ebony Hodge. There are 9 children enrolled, and 0 children present at the time of inspection. The hours of operation are Monday- Friday from 12:00am-12:00a.m. All adults in the home were discussed and background and fingerprinted cleared. License, Facility sketch, disaster plan and PUB 394 posted. Licensee does have a current disaster log drill with 9/3/24. Licensee does have current 9040 (facility roster).

This is a one story home which consists of three bedrooms, two bathrooms, kitchen/dining room, living room, a detached garage, driveway, front yard and backyard (fenced). The off-limit areas include three bedrooms, one bathroom, backyard, and detached garage.



The main care area has a dramatic play area, table with chairs, arts & crafts material, library area, and cubbies for children belongings. LPA did not observe any sharp or loose objects.

The kitchen area is accessible to children. LPA Dunlap observed all knives, cleaning products, poisons inaccessible to children in cabinets with safety latches.

The bathroom area has cleaning products inaccessible to children in a cabinet below the sink with safety latch.
At 10:30am., LPA Dunlap observed 2 off limit doors open. LPA Dunlap told the Licensee that all doors that are off limits must remain locked. The Licensee immediately locked the doors.

The outdoor play area has age-appropriate toys and materials. There is an off limits backyard that has a
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: HODGE FAMILY CHILD CARE
FACILITY NUMBER: 198012887
VISIT DATE: 10/18/2024
NARRATIVE
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a large body of water on premises. At 10:40a.m., LPA Dunlap observed a jacuzzi with locked latches. The Licensee stood on top of the padding cover to demonstrate that it can hold the weight of an adult.

LPA’s observed the smoke detector and carbon monoxide detector to be operable.

LPA’s observed a fire extinguisher with an expiration date of 9/7/24.

Staff Files:

Staff # 1

Files have required licensing documents in folders.

CPR expiration date of 4/1/25

Mandated Reporter expiration date of 9/2/26

Missing required immunization record & CPR & First Aid missing pediatric sticker.

This poses a potential health, safety or personal rights risk to persons in care. Type B deficiency will be cited.



Child #1

All required licensing forms are in file.

Missing immunization record.

Child #2

At 11:00a.m.LPA observed all required licensing forms are in file with the exception of the LIC9227 and Safe Sleep Log. LPA Dunlap gave the Licensee the LIC9227 form. This poses a potential health, safety or personal rights risk to persons in care. Type B deficiency will be cited.

Child #2 missing immunization record.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
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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: HODGE FAMILY CHILD CARE
FACILITY NUMBER: 198012887
VISIT DATE: 10/18/2024
NARRATIVE
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Child #3

All required licensing forms are in file

Missing immunization record.

Child #4

All required licensing forms are in file.

Missing immunization record.

4 out of 4 children files were missing immunization records. This poses a potential health, safety or personal rights risk to persons in care. Type B deficiency will be cited.

The Licensee stated that they communicate with parents via phone, and/or person. The Licensee has a landline and cell phone that they use.



The Licensee stated they do not have any children that they administer medication to at this time.

The Licensee states that when children are in sick, they are placed keep in living room.

The Licensee stated there are no firearms in the home.

The Licensee stated that there are no smokers in the home.

The Licensee stated that they does provide transportation for children in the morning and afternoon.

The Licensee stated they do not have any children with allergies. The serve breakfast and snack.

The Licensee stated that does have first aid kit.

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

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
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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: HODGE FAMILY CHILD CARE
FACILITY NUMBER: 198012887
VISIT DATE: 10/18/2024
NARRATIVE
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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

Criminal Record Clearance - Family Child Care Homes Licensee Ebony Hodge 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.

Safe Sleep

LPA discussed the safe sleep regulations with Licensee Ebony Hodge 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 Licensee Ebony Hodge 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-carecenters/.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee Ebony Hodge 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.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
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: HODGE FAMILY CHILD CARE
FACILITY NUMBER: 198012887
VISIT DATE: 10/18/2024
NARRATIVE
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MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] 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.

Megan’s Law - Family Child Care Homes During the exit interview, the Licensee Ebony Hodge, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

4 Type B deficiencies will be cited during todays inspection.

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

Appeal rights explained and given to Licensee Ebony Hodge.

Exit interview conducted and report was reviewed with the Licensee Ebony Hodge.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2024 07:28 AM - It Cannot Be Edited


Created By: Keneisha Dunlap On 10/18/2024 at 12:29 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: HODGE FAMILY CHILD CARE
FACILITY NUMBER: 198012887

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in staff file for the Licensee missing immunization record, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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The Licensee will obtain current records by POC date.
The Licensee will place in file when received.
The Licensee will email LPA copy of proof by POC date.
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
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Based on record review, the licensee did not comply with the section cited above in staff file for the Licensee CPR & First Aid card missing pediatric sticker which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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The Licensee will obtain correct card by POC date.
The Licensee will place in file when received.
The Licensee will email LPA copy of proof by POC 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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2024 07:28 AM - It Cannot Be Edited


Created By: Keneisha Dunlap On 10/18/2024 at 12:29 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: HODGE FAMILY CHILD CARE
FACILITY NUMBER: 198012887

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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4
Based on record review, the licensee did not comply with the section cited above in4 out of 4 children files were missing immunization records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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The Licensee will obtain immunization records from parent(s) for children files.
The Licensee will place in children files when received from parents.
The Licensee will email LPA copy of proof by POC date.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above in 1 out of 4 childre files were missiing the LIC9227 form, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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2
3
4
The Licensee was given LIC9227 form by LPA Dunlap
The Licensee will have parent file out LIC9227 form.
The Licensee will email LPA copy of proof by POC 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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2024


LIC809 (FAS) - (06/04)
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