198016841-2-12-2025-54-CC-PBIP-DDTU9H-20250212142310

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016841
Report Date: 02/12/2025
Date Signed: 02/12/2025 02:23:19 PM

Document Has Been Signed on 02/12/2025 02:23 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:	198016841
ADMINISTRATOR/ DIRECTOR:	MOORE, DONICE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 220-7683
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 2	DATE:	02/12/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Donice Moore		TIME VISIT/ INSPECTION COMPLETED:	02:45 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 Analyst (LPA) Peter Bishop arrived at the above facility for the purpose of an Unannounced Annual Visit at 11:30 AM. Upon arrival, LPA Bishop announced the purpose of the visit and was granted entry into the facility by Licensee Donice Moore who provided tour of facility. LPA 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. Per licensee, the current hours of care provided are Monday – Friday 6:00 am -- 6:00 pm at the time of inspection no overnight care is provided. There were 2 children present during today's inspection. There are 6 children currently enrolled. Licensee stated that she and her daughter are the only one that lives here, and current criminal background clearance. LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness forms. Licensee was advised to post the required documents on the parent board. At 1145 AM, LPA Bishop was given a tour of the facility. This is single - family home consists of three bedrooms, two bathrooms, kitchen, living/dining area and backyard. Per licensee, the areas used by children include: Living Room, Bathroom 1 and outside play area. Outside play area was made inaccessible today because of the rain. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation, and heating. Off limit areas are all bedrooms, bathroom 2, kitchen area and garage. Licensee states that the living room will be used as a isolation area for sick children waiting to be picked up by a parent. 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. At 12:00 PM, life-saving devices were inspected throughout the home. The smoke detector is located above the entrance of the kitchen. The carbon monoxide detector is located in the kitchen above the rear door of the 1 of 4

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Peter Bishop
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198016841
	VISIT DATE: 02/12/2025

NARRATIVE

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home. All devices were tested and operable. The 2A 10 BC Fire extinguisher is located in the kitchen and did not display last service date and it is not in compliance. Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone/LAN line.

At 12:15 PM Living room (Main care area) was observed to be clean and orderly. There are toys and other age-appropriate materials for the children. LPA observed the living room to have one table for children and there were colorful storage boxes, and individual cubbies for toys.

At 12:30 PM, LPA observed the kitchen. Licensee stated that the baby gate is always present to make off limits kitchen inaccessible to children in care. Licensee stated that cleaning compounds in the bathroom in an inaccessible cabinet. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.

At 12:30 PM, LPA observed that the bathroom the children use is clean and free of floor hazards. There was toilet paper, hand-washing soap, and towels for the children. LPA did not observed any chemicals stored under the sink.

Per Licensee there are no firearms or weapons stored in the home. LPA did not observe any firearms or weapons in the home. Licensee states that there are no body of water present. LPA did not observe any bodies of water on the premises.

At 1:00 PM, LPA observed the back yard for outdoor play. The outdoor play area was observed to be completely fenced. At the time of the inspection there were three slides and other age appropriate toys. There was also a shaded area for the children as well. Licensee stated that they do not have any pets at the time of this inspection.

At 12:15, Staff records were reviewed for approved Pediatric First Aid and CPR certification. Valid CPR/First Aide was available at the time of inspection Licensee Moore is valid through 01/12/2026 Personnel Record, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment available at the time of the visits.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Peter Bishop
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198016841
	VISIT DATE: 02/12/2025

NARRATIVE

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against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment available at the time of the visits. LIC 9108- Statement Acknowledging Requirement to Report Child Abuse is available and current Mandated Reporter Training Certificate was available with an expiration date of 04/01/2026.

Children’s records were reviewed LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents rights and Immunizations were all current and up to date.

The following information was discussed:
LPA discussed the safe sleep regulations with licensee Licensee Moore and discussed the Child Care Licensing Safe Sleep. Also, webpage resources provided at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA P Bishop also informed Licensee Moore 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/.

Criminal Record Clearance - Family Child Care Homes - Licensee Moore 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.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Peter Bishop
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198016841
	VISIT DATE: 02/12/2025

NARRATIVE

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Licensee Moore was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on the LPA Bishops observations, record review,and interviews, there wiil be one deficiency cited today in accordance with California Title 22 Regulations.Based on LPA observation and inteview, fire extinguisher did not meet above requirement. LPA observed fire extinguisher tag did not have a date. This poses a potential health, safety, and personal rights risk to children in care.

During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders (RSO) living in the facility and LPA completed the RSO search in Megan’s Law Website.
A notice of site visit was given and must remain posted for 30 days. Failure to post will result in a $100 civil penalty. Exit interview conducted and report was reviewed with the Licensee Moore.
A copy of the report and appeal rights was given to Licensee Moore.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Peter Bishop
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/12/2025 02:23 PM - It Cannot Be Edited

Created By: Peter Bishop On 02/12/2025 at 01:53 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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198016841
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above in one out of one which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/21/2025
	Plan of Correction
1 2 3 4	Licensee stated she would buy a new fire extinguisher and send LPA Bishop the receipt.

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:

Peter Bishop

LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

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