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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013548
Report Date: 07/19/2023
Date Signed: 07/20/2023 07:30:58 AM

Document Has Been Signed on 07/20/2023 07:30 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
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: 14CENSUS: 2DATE:
07/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:RayJennia Adams, LicenseeTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. Upon arrival at 12:30pm LPA met with Licensee, RayJennia Adams, who provided tour of facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access, as well as off limit areas. Per licensee, the current hours of operation are Monday-Saturday 9:00am - - 10:00pm. The licensee provides overnight care from 10:00pm - 7am. LPA discussed with licensee that Overnight Care regulations. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered care. There were 2 children present observed to be supervised by Shiree Adams, Assistant. All adults present have been cleared and associated. Individuals residing in the home were discussed and noted.

This is is a two level, six (6) bedrooms and five bathrooms home. The main day-care areas are the den (classroom). Per licensee, the areas used by children include: Den (classroom), game room, bathroom adjacent to the den, bedroom and bathroom in hallway (by kitchen). Front yard and backyard. The children have access to the living room, kitchen and laundry area.

Off limit areas are: Entire second level (bedroom, two bathrooms, office and bar room. Two bedrooms in the hallway by kitchen. There is a gate at the base of the stairs, observed to be closed, making the upstairs inaccessible. Off limits bedrooms were observed to be closed.

Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. Rooms that are off-limits need to be made inaccessible during operating hours. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

The bathrooms used by children in the classroom and in the hallway was observed to be clean and free of hazards. The licensee was reminded to maintain the home clean and orderly. Page 1 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ADAMS & MCCRAW FAMILY CHILD CARE
FACILITY NUMBER: 198013548
VISIT DATE: 07/19/2023
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The front yard is enclosed, has toys and other materials for children to play with including a large trampoline with a cover to make sure it is only used as recommended by manufacturer. Per licensee, only one child used the trampoline at a time and they are always supervised. LPA did not observe any objects that could be hazardous to children in care.

LPA observed a caged bird as a pet in the home. LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted in the hallway by facility entrance. Licensee was advised to post the required posted documentation in a location visible to parent/guardians of children in care. LPA reviewed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 06/7/22, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone and LAN line. There are toys and other age-appropriate material available. LPA observed that cleaning compounds are in kitchen undersink cabinet locked and inaccessible to children in care.


Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.
Per Licensee there are no firearms or weapons stored in the home. Isolation area for sick children waiting to be picked up is in in the living room or classroom, supervised and away from the other children.

Per licensee and facility records there are currently no infants in care. 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.

Currently, children are using the back/front yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the backyard is enclosed with some items that are potentially a hazard to children in care; there is a fire pit with a rusted top and ripped cover. LPA observed that there is jacuzzi filled with items (currently used as storage). LPA advised licensee to make sure the outdoor space is free of clutter and remove broken items that might be a hazard to children in care. -------------------Page 2 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ADAMS & MCCRAW FAMILY CHILD CARE
FACILITY NUMBER: 198013548
VISIT DATE: 07/19/2023
NARRATIVE
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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Staff 1 is missing immunization records and TB test.

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/

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

Licensee 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.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations. Licensee 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. 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, RayJennia Adams. Appeal Right were discussed.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/20/2023 07:30 AM - It Cannot Be Edited


Created By: Alicia Mooberry On 07/19/2023 at 02:56 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: 07/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that there is a fire pit observed in the children's play area in the backyard which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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Per licensee, the fire pit will be removed today and a photo will be sent to LPA by POC due date.
Type B
Section Cited
CCR
102426(a)(3)
Overnight Care
To provide overnight care, the provider shall meet the following requirements: If the sleeping arrangements are not situated in such a way that the provider can be assured of hearing a child in care wake up, a digital video and audio monitoring device shall be used.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Observation and interview, the licensee did not comply with the section cited above, the licensee cares for children overnight, in separate bedroom from licensee and there is no digital video and audio monitoring device which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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The licensee ordered a video/audio monitor during inspection that is scheduled to be delivered by 7/20/23, licensee will send a photo as proof of correction by POC due 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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 07/20/2023 07:30 AM - It Cannot Be Edited


Created By: Alicia Mooberry On 07/19/2023 at 02:56 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: 07/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Administration of Child Day Care Licensing
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that Staff 1 did not have proof of immunization on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2023
Plan of Correction
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Per licensee, proof of immunization for Shirre Adams will be sent to the department via email by POC due 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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023


LIC809 (FAS) - (06/04)
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