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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016988
Report Date: 01/02/2025
Date Signed: 01/02/2025 04:23:31 PM

Document Has Been Signed on 01/02/2025 04:23 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LEWIS FAMILY CHILD CAREFACILITY NUMBER:
198016988
ADMINISTRATOR/
DIRECTOR:		LEWIS, ALANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 261-8975
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 1DATE:
01/02/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Licensee, Alan LewisTIME VISIT/
INSPECTION COMPLETED:
04:45 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
On January 2, 2025, at 2:25 pm Licensing Program Analysts (LPAs) Priscilla Ochoa and Kamile Martin conducted an unannounced annual inspection at the above facility. LPA was greeted by licensee, Alana Lewis who guided LPAs on a tour of the facility. All adults present during the inspection have criminal record clearance. Per licensee there are 10 children enrolled and LPAs observed 1 child in care. Hours of operation are Monday through Friday from 7:00 am to 5:00 pm. LPA provided a copy of Entrance Checklist—Family Childcare Home (LIC126) to licensee.

Family members residing in the home are 1 adults who have criminal record clearance. This is a single-story home that consists of 2 bedrooms, 1 bathroom, kitchen, living room, laundry room, front yard, backyard (fenced) and ADU (playroom).

Off limit areas include 1 bedroom, kitchen, laundry room and front yard.

Areas accessible to children are the bathroom, 1 bedroom, living room, ADU (playroom), and backyard which is fenced.

At 2:35 pm, licensee guided LPAs on a tour of the areas that are accessible to the children in care. Upon entrance from the front door, LPAs observed the living room where a child was napping. LPAs did observe a fireplace in the living room, which was barricaded and made inaccessible to children in care. Then LPAs observed bedroom 1 where serval age-appropriate toys were observed, licensee’s office materials such as a desk and children’s cubbies. Napping equipment in the form of cots were also observed to be stored in the accessible bedroom. Napping equipment was observed to be clean and orderly. Per licensee, bedding is washed at the facility daily. LPAs then inspected the bathroom which is next to bedroom 1 across the living room. Bathroom was inspected and was clean. LPAs observed cleaning solutions to be next to the toilet paper storage. LPAs discussed with licensee that cleaning solutions should be inaccessible to children in care.

Page 1 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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 7
Document Has Been Signed on 01/02/2025 04:23 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 01/02/2025 at 03:36 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 198016988

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review,the licensee did not comply with the section cited above as LPAs could not test carbon monoxide as licensee could not locate it which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/06/2025
Plan of Correction
1
2
3
4
Licensee will send LPA P. Ochoa a video of functioning carbon monoxide detector by POC date of 01/06/2025.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above as licensee could not provide proof of immunization record, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
1
2
3
4
Licensee will send LPA P.Ochoa proof of immunization record that licensee is immunized with pertussis, measles, TB and influenza or a statement declining the influenza by POC daye 1/17/2025
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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 01/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2025


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 01/02/2025 04:23 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 01/02/2025 at 03:36 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 198016988

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 children files did not have LIC995A which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
1
2
3
4
Licensee will submit to LPA P.Ochoa completed LIC995A for C1 and C2 by POC date of 1/10/2025

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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 01/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2025


LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 198016988
VISIT DATE: 01/02/2025
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 right away removed cleaning solutions and put them in the kitchen where they are inaccessible. LPAs then inspected the backyard which is fenced and observed more age-appropriate toys for children in care and a play structure with swings. Then the ADU (playroom) was inspected where several age-appropriate toys were observed along will parent board. All areas were observed to be clean, orderly, comfortable, and well ventilated.

There are first aid supplies available. Per licensee, the facility provides all meals to children in care. The bedroom is being used as an isolation area at this time. A cot is available if needed.

Licensee's poisons, detergent, cleaning compounds, medications and other items which could pose a danger to child are stored where they are inaccessible to children.

LPAs observed a functional smoke detector in the playroom. LPAs did not test a Carbon Monoxide detector as licensee could not locate it. A 2A-10BC fire extinguisher was observed and was serviced on 12/28/2024. There is a working telephone on site.

Per the licensee, there are no firearms or pets on the premises. Licensee obtained current Pediatric First Aid and CPR certification expires on 9/28/2026.

LPAs conducted a children file review and deemed not complete. 2 out of 2 files did not have LIC995A Parent Rights. Licensee will receive a technical violation for not properly documents safe sleep 15 minutes checks. Licensee did provide proof of 15 minute safe sleep logs. Chart that was provided to LPAs to inspect, did not have proper documentation. Licensee mention they do not document the position the infant was laid down on and through the 15 minute checks. LPAs provided licensee a safe sleep log to used and document what the regulation requires. LPAs also advised licensee to go over safe sleep regulation.

LPAs conducted staff file review and deemed not complete. Licensee could not provide proof of immunization record.

Licensee completed Mandated Reporter training and expires on 12/28/2026. All childcare employees must complete mandated reporter training within 30 days of hire and renew training every two years at www.mandatedreporterca.com

Page 2 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 198016988
VISIT DATE: 01/02/2025
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
Per the licensee, fire and disaster drills are conducted every 6 months; last drill documented and conducted on 12/27/2024.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) and Emergency Disaster Plan (LIC610a) to be posted.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The on Duty Worker is available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507

The following was discussed with the licensee:


Capacity requirements, Roster requirements, Posting requirements, Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, and Safe Sleep Awareness. The role and responsibilities of being a mandated reporter were reviewed. Licensee was reminded that supervision is always required to children in care.

Page 3 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 198016988
VISIT DATE: 01/02/2025
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 made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified.

Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

--Licensee was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.


-- Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

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-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

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

The licensee, Alana Lewis confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. LPA provided consultation during inspection.

Based on the LPA’s observations and record review, the following deficiencies listed on the attached LIC 809D (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 and safety.

A notice of site visit was given and must remain posted for 30 days during facility’s hours of operation. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted, and a copy of the report was provided to licensee, January 2, 2025.

Page 4 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC809 (FAS) - (06/04)
Page: 7 of 7