198013169-3-10-2025-54-CC-KDUP-DEMUN2-20250310154313

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013169
Report Date: 03/10/2025
Date Signed: 03/10/2025 03:43:37 PM

Document Has Been Signed on 03/10/2025 03:43 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:	DOUGLAS FAMILY CHILD CARE		FACILITY NUMBER:	198013169
ADMINISTRATOR/ DIRECTOR:	DOUGLAS, SHAKENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 375-3636
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	03/10/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:25 PM
MET WITH:	Licensee- Shakena Douglas		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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On March 10, 2025, at 12:25p.m., Licensing Program Analyst (LPA) Keneisha Dunlap 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 Assistant- Jordan Grayson. There are 21 children enrolled, and 5 children present at the time of inspection. The hours of operation are Monday- Friday from 12:00am-11:00pm. All adults in the home were discussed and background and fingerprinted cleared. License, disaster plan, posted. The Licensee does have a current disaster log drill with the date of 12/2/24. The Licensee does have current LIC 9040 (facility roster).

At 1:00p.m., LPA Dunlap observed missing PUB 394 posted earthquake disaster checklist (LIC9148). LPA notified the Licensee of the missing documents and provided the Licensee with copies. The Licensee posted during the inspection. This poses an immediate health and safety and personal rights risk to children in care. Technical Assistant will be issued.

The Licensee- Shakena Douglas arrived for inspection at 1:45p.m.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen/dining room, 2 living rooms, a detached garage that has been converted into a living space, front yard fenced and backyard. The off-limit areas include 3 bedrooms, 1 bathroom, kitchen/dining area, detached garage, and backyard. Heating & Cooling units.

The main care area is the living room 1. LPA observed a wall mounted television, heating & cooling, wooden storage lockers for personal belongings, 5 highchair feeding tables, child sized tables, child sized chairs, age-appropriate toys, art materials, dramatic play area, manipulative items, and napping cots. LPA observed all furnishings, equipment, and material to be in good condition.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

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: DOUGLAS FAMILY CHILD CARE	FACILITY NUMBER: 198013169
	VISIT DATE: 03/10/2025

NARRATIVE

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Living room 2 was observed with 5 playpens, heating & cooling system with wall mounted barricade, reading area, a storage cubby for personal belongings, a wall mounted television and a child sized table with chairs, dramatic play area, and age-appropriate chairs and tables. A sliding wooden door& baby gate was observed to separate living room 2 and the off-limits kitchen area. LPA observed all furnishings, equipment, and material to be in good condition.

LPA Dunlap observed the bathroom 1 has an operable toilet and sink. LPA Dunlap observed the drawers to have no items in it.
At 1:00p.m., LPA Dunlap observed a wall cabinet with no safety latch with a bottle of witch hazel. LPA notified the Licensee that they cannot store in cabinet without safety latch. The Licensee removed during visit and placed in off limits area. This poses an immediate health and safety risk to children in care. Technical Violation will be issued.

The outdoor area for play is the back yard which is fenced. The yard has shaded structure, artificial grass, manipulative items, dramatic play area, playhouse, crawl tunnel, age-appropriate tables & chairs, tricycles, balls, scooters, wagons, slide structure, age-appropriate toys, and relaxation reading area with soft cushions. LPA observed outdoor area to be in good condition, free of sharp, loose, or pointed parts.

LPA Dunlap observed a fire extinguisher 2A-10BC with expired receipt date of 2023 (full date was not legible to due to receipt being faded). LPA Dunlap informed the Licensee of expired fire extinguisher. The Licensee had the Assistant purchase a fire extinguisher 2A-10BC during visit. LPA Dunlap observed fire extinguisher 2A-10BC with purchase date of 3/10/25. This poses an immediate health and safety risk to children in care. Technical Violation will be issued.

LPA observed a dual smoke detector and carbon monoxide detector to be operable.

The Licensee stated that they do provide meals for children.

The Licensee stated they use a cell phone.
The Licensee stated they do not have any children that they administer medication to at this time.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/10/2025 03:43 PM - It Cannot Be Edited

Created By: Keneisha Dunlap On 03/10/2025 at 03:18 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: DOUGLAS FAMILY CHILD CARE	FACILITY NUMBER: 198013169
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(a)(6)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 3 staff records missing Health & Safety Certifciates which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/29/2025
	Plan of Correction
1 2 3 4	All staff must show proof of completing course The Licensee must keep certificates in staff files The Licensee will submit of proof of certificates to LPA via email by POC date.

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:

Karen Chambers

LICENSING EVALUATOR NAME:

Keneisha Dunlap

LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

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: DOUGLAS FAMILY CHILD CARE	FACILITY NUMBER: 198013169
	VISIT DATE: 03/10/2025

NARRATIVE

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The Licensee stated that when children are sick, they are placed by the door in the main care area.

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 do provide transportation for children.

The Licensee stated that they do have a first aid kit.

The Licensee stated that they do provide nap time. Cots are stored in the main care room.

Staff Files:

Staff # 1

File has all required licensing documents and immunization record in folder (except Health & Safety Certificate).

CPR expiration date of 9/21/25

Mandated Reporter expiration date of 1/8/27

Staff # 2

File has all required licensing documents and immunization record in folder (except Health & Safety Certificate)..

CPR expiration date of 9/21/25

Mandated Reporter expiration date of 1/7/27

Staff # 3

File has all required licensing documents and immunization record in folder (except Health & Safety Certificate).

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC809 (FAS) - (06/04)

Page: 8 of 10

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: DOUGLAS FAMILY CHILD CARE	FACILITY NUMBER: 198013169
	VISIT DATE: 03/10/2025

NARRATIVE

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Mandated Reporter expiration date of 3/5/27

All staff missing Health & Safety Certificates. This poses an immediate health and safety risk to children in care. Type B will be issued.

Staff 3 missing CPR certificate. This poses an immediate health and safety risk to children in care. Technical Violation will be issued.

Children Files

Child #1

All required licensing forms and immunization record are in file.

Child #2

All required licensing forms and immunization record are in file.

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

Criminal Record Clearance - Family Child Care Homes Licensee-Shakena Douglas 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- Shakena Douglas and discussed the Child Care Licensing Page 4 of 5

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC809 (FAS) - (06/04)

Page: 9 of 10

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: DOUGLAS FAMILY CHILD CARE	FACILITY NUMBER: 198013169
	VISIT DATE: 03/10/2025

NARRATIVE

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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- Silvia Olmos 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)

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- Shakena Douglas 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- Shakena Douglas 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.

Appeal rights explained and given to Licensee- Shakena Douglas.

1 Type B deficiency will be issued.

3 Technical Violations issued during today’s inspection.

1 Technical Assistant issued during today’s inspection.

Exit interview conducted and report was reviewed with the Licensee- Shakena Douglas.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC809 (FAS) - (06/04)

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