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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400052
Report Date: 09/02/2021
Date Signed: 09/02/2021 01:32:02 PM

Document Has Been Signed on 09/02/2021 01:32 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:LACKEY FAMILY CHILD CAREFACILITY NUMBER:
198400052
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Tameika Lackey, LicenseeTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced Required inspection to the above facility. Licensing staff met with Tameika Lackey, Licensee who guided analyst on a tour of the facility. Also present during this inspection was Licensee’s Assistant, Kimberly Miller. Tour began at 11:57am. At 12:00pm, Licensee left to pick up children from school and tour continued with Licensee Assistant. The licensee assistant states that she currently has 6 children enrolled. During this inspection there were 1 child, 1 school age child and 2 infants present. A children’s roster is available and is current. Per Licensee, hours of operation are 6am to 6pm, Monday to Friday. Licensee returned on 12:13pm with an additional school age child. Two additional children arrived at 12:20pm.

All areas identified on the facility sketch were inspected. This is single family home consisting of two bedrooms, one bathroom, living room, kitchen, dining room, garage unit, front and backyard. The licensee uses the living room, detached back garage (for diapering when children are outside), dining room, bathroom and backyard for daycare. All other rooms are off limits. Areas off limits include: All bedrooms and front yard.

The licensee states that 2 adult currently live in the home. Licensee states that she currently has two assistants. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, telephone service (cell phone) , ventilation and heating (central). The following was observed and reviewed during this inspection.

PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. Licensee's state that all poisons and clean compounds are kept in a locked in the hallway closet.
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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2021
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: LACKEY FAMILY CHILD CARE
FACILITY NUMBER: 198400052
VISIT DATE: 09/02/2021
NARRATIVE
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The valve on the required 2A 10BC fire extinguisher indicates fully charged however there is no proof of the last time fire extinguisher was last service. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and Carbon detector was tested and is operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 09/02/21.

There is heating and ventilation for safety and comfort. There are toys available for children. The licensee states that there is a cell phone that is used and stays at the facility during operating hours.

The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. The licensee states that supervision is provided at all times. Per Licensee they are using a inflatable pool when it's hot. Per Licensee, water is dumped out as soon as children are done using the pool.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR which expire 05/2023. Lead poisoning training was taken on 05/23/2021.

H&S 1597.622: 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.
The following items were also discussed with licensee during this inspection.
PETS: There are two small dogs on the premises.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted in the entrance of the home.
PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility. No sleeping children in CARSEATS. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.

LPA discussed Department of Public Health, Early Care and Education Guidance COVID-19 recommendations. PIN 20-24 was given and explained.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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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: LACKEY FAMILY CHILD CARE
FACILITY NUMBER: 198400052
VISIT DATE: 09/02/2021
NARRATIVE
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Infant Care: Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. The licensee stated the following as a supervision plan for infants: Licensee states that infants sleep in the dining room. LPA provided the licensee with a copy of the Child Care Pro. LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.govAB1207 Mandated Child Abuse Reporter training will expire on 02/17/2023.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.



Deficiency is cited on the D- Page.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with licensee. Appeal Rights were given and explained.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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Document Has Been Signed on 09/02/2021 01:32 PM - It Cannot Be Edited


Created By: Susann Sanchez On 09/02/2021 at 12:44 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: LACKEY FAMILY CHILD CARE
FACILITY NUMBER: 198400052

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2021
Section Cited
CCR
102417(g)(1)

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Operation of a Family Child Care Home
The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement is not met as evidenced by LPAs observed no proof of fire extinguisher service tag or purchase receipt.This poses a potential risk to the
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 Per LIcensee, will submit a picture of the service tag to the LPA by POC due date 9/30/2021.
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heealth and safety of childern in care.
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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:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2021


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