198015828-9-19-2024-54-CC-MMEO-D99RNT-20240919131050

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015828
Report Date: 09/16/2024
Date Signed: 09/19/2024 01:11:40 PM

Document Has Been Signed on 09/19/2024 01:11 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:	MOORE FAMILY CHILD CARE		FACILITY NUMBER:	198015828
ADMINISTRATOR/ DIRECTOR:	MOORE, ASHLEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 925-7353
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 6	DATE:	09/16/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:10 AM
MET WITH:	MOORE, ASHLEY / LICENSEE		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

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 Analyst (LPA) Ashley Calderon conducted an unannounced annual random inspection at the above facility. LPA met with Ashley Moore/ Licensee who allowed LPA entry to the facility. There were 6 children (1 was an infant), and 2 staff members present when LPA arrived. There were 3 additional adults in the home who were fingerprinted cleared. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon-Fri 7:30AM - 6:00PM. LPA conducted a tour with A.Moore: This is a one-story home which consists of 4 bedrooms, 2 bathrooms, kitchen, dining room, living room, family room, patio room (day-care room), garage, front yard and backyard (fenced). The children use the bathroom in the hallway,the patio/ daycare room, and the backyard. Per licensee, areas off limits to children and parents include: all bedrooms, living room, kitchen, one bathroom, garage and front yard. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 08/27/2024. Per Licensee prefers to do monthly drills. LPA notified Licensee drills per regulations are required to be conducted every 6 months. Smoke and carbon monoxide detectors were tested and are operable. The 2A10BC fire extinguisher was last serviced on 07/17/2024. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. (Page 1/3...)

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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 09/19/2024 01:11 PM - It Cannot Be Edited

Created By: Ashley Calderon On 09/16/2024 at 10:34 AM

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198015828
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102325(j)(2)(D)(c)

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation Licensee only had blank samples of sleep log, and per interview with licensee will start as of today 15 min sleep log for Child #2 , per Child #2 record review no sleep log in file, the licensee did not comply with the section cited above in [1] out of [1] person which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Licensee will provide LPA Calderon with Child #2 sleep log records on poc due 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:

Valarie Cook

LICENSING EVALUATOR NAME:

Ashley Calderon

LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198015828
	VISIT DATE: 09/16/2024

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
26
27
28
29
30
31
32

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.

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.

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/.

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. Based on the LPA’s observations and records review, the following deficiency listed on the attached LIC 809-D (deficiency page) 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. Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Ashley Moore. (Page 3/3, end of report)

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198015828
	VISIT DATE: 09/16/2024

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
26
27
28
29
30
31
32

Detergents, cleaning compounds and medication are stored in in the garage, inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children if present in the facility. Isolation area for sick children waiting to be picked up is in corner of the daycare room, away from the other children. Per Licensee there are no firearms or weapons stored in the home, no pets, no children medication stored at the facility or given and transportation is not provided.

Kitchen was observed to have baby safety latches on cabinets, sharps was observed in day care room cabinets with safety locks inaccessible to children in care were in place. Per Licensee, provides food to children in care.Currently, children are going on nature walks and on today's visit outdoor play is temporary not being used, per licensee due to objects and items that will be hauled away later today. The outdoor play area was observed to be fenced. LPA's observed that the outdoor yard has toys and other materials for children to play with. There are no pools or spas, or other bodies of water.

Children’s records were reviewed, total (5) for: (LIC) 282- Affidavit Regarding Liability Insurance, Immunizations Records, LIC 700- Identification and Emergency Information, LIC 995A Notification of Parents’ Right. Infant record was reviewed for Child #2, C2 did not have 15 min sleep log in child's records there for a deficiency noted. Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance and Mandated Reporter Training Certificate. All staff had valid certifications in file and had all records required.

Consultation was given regarding Additional Children LIC9150 and 311D Records/Forms was reviewed. LPA conducted staff interview.

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. (Page 2/3...)

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4