<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013548
Report Date: 07/20/2022
Date Signed: 07/20/2022 03:54:38 PM

Document Has Been Signed on 07/20/2022 03:54 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:ADAMS & MCCRAW FAMILY CHILD CAREFACILITY NUMBER:
198013548
ADMINISTRATOR:ADAMS, RAYJENNIA&MCCRAW, MFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 564-0901
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 11DATE:
07/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:RayJennia Adams, LicenseeTIME COMPLETED:
04:00 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
Licensing Program Analysts (LPAs) Alicia Mooberry and Austin Estrada conducted an unannounced case management inspection to the above facility. LPAs met with RayJennia Adams Licensee, who guided analysts on a tour of the facility. There were 11 children present, Also present was Mack McCraw, Co-licensee, Shiree Adams, and James Adams, Assistants. All adults present in the home have obtained a Criminal Record Clearance.

During the inspection LPAs observed that a can of Raid on a table in the living room, accessible to children in care. This poses an immediate risk to the health and safety of children in care. LPAs observed a small trampoline in the front play area with exposed metal springs, no children were present at the time, this poses a potential risk to children in care. The trampoline was removed during this visit. LPA observed a large trampoline with a safety net, LPA reminded licensee to ensure the trampoline is uses according to manufacturer recommendations. LPAs observed that the back yard where children play has clutter, with the grill not covered, tools accessible to children in care, toys that are not clean and not in good condition posing a potential risk to the health and safety of children in care. LPAs reviewed the facility roster and found it to be incomplete posing a potential risk to the health and safety of children in care.

A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days



Exit interview was conducted with Ray Jennia Adams, Licensee, including Appeal Rights and agency's consultative role.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 07/20/2022 03:54 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 07/20/2022 at 02:51 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: ADAMS & MCCRAW FAMILY CHILD CARE
FACILITY NUMBER: 198013548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/20/2022
Section Cited
CCR
102417(g)(A)

1
2
3
4
5
6
7
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Storage areas for poisons, firearms and other dangerous weapons shall be locked.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee removed the can of Raid out of the areas accessible to children in care. Deficiency corrected during visit.
8
9
10
11
12
13
14
LPAs observed a can of Raid on the coffee table in the living room that is accessible to children in care. This poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 07/20/2022 03:54 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 07/20/2022 at 02:58 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: ADAMS & MCCRAW FAMILY CHILD CARE
FACILITY NUMBER: 198013548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2022
Section Cited
CCR
102417(d)

1
2
3
4
5
6
7
(d) The home shall provide safe toys, play equipment and materials.


This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The trampoline was removed and deficeincy was corrected during inspection.
8
9
10
11
12
13
14
LPAs observed a small trampoline in the front play area with exposed metal springs, no children were present at the time, this poses a potential risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
8
9
10
11
12
13
14
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022


LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 07/20/2022 03:54 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 07/20/2022 at 03:04 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: ADAMS & MCCRAW FAMILY CHILD CARE
FACILITY NUMBER: 198013548

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2022
Section Cited
CCR
102417(g)

1
2
3
4
5
6
7
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:
1
2
3
4
5
6
7
Per licensee, they will remove items that are potentially and provide proof of corrention to LPA via email by POC due date
8
9
10
11
12
13
14
LPAs observed that the back yard where children play is cluttered, with the grill not covered, tools accessible to children in care, toys that are not clean and not in good condition posing a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
07/22/2022
Section Cited
HSC1596.841

1
2
3
4
5
6
7
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include ...the name and telephone number of the child's physician.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per licensee, the Facility Roster will be completed and sent to LPA via email by POC due date
8
9
10
11
12
13
14
Per record review, the roster was missingchildren's information including physician name and parent information. THis posed a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022


LIC809 (FAS) - (06/04)
Page: 3 of 4