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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400286
Report Date: 12/13/2023
Date Signed: 12/13/2023 12:31:55 PM

Document Has Been Signed on 12/13/2023 12:31 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 CAREFACILITY NUMBER:
198400286
ADMINISTRATOR:CHRYSTAL MOOREFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 362-9727
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
12/13/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee - Chrystal MooreTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required 3 year inspection to the above facility on 12/13/23. LPA arrived at the facility at 9:30 AM and met with licensee Chrystal Moore, who guided analyst on a tour of the facility. Also present during this inspection was an assistant. Per Licensee, there are 10 children that are currently enrolled. There were 9 children present upon arrival, 3 of which are infants.

This is a one-story home which consists of 3 bedrooms, 1 bathroom, kitchen/dining room, living room, a detached garage, front yard and backyard (fenced). The off limit areas include 3 bedrooms, detached garage and front yard. The backyard is temporarily off-limits during inspection due to a home repair project. LPA observed that the repair project does not impede on any other areas of the home designated for care

The main care area is located in the living room. LPA observed a couch, art supplies, a television, age appropriate toys, and toddler climbing equipment. Napping mats were observed to be stored in the corner of the main care area. Per licensee, infants currently nap on the mats. Licensee states she does not have a crib or a playpen for infants to nap in. LPA advised licensee that a citation under California Code of Regulation (CCR) section 102425(a) will be issued. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted on a wall behind the front door. The kitchen was observed to be clean and free of any defects. Cleaning supplies were observed to be locked beneath the kitchen sink. Knives and other pointy objects were observed to be kept in a locked cabinet beneath the kitchen counter. Per licensee, she provides food for children in care. Licensee also states that isolation area for children showing signs of illness will be located by the front door while they await parent pick up. Licensee also understands any food brought from home must be properly labeled and stored or refrigerated. The bathroom was observed to be clean with an operable sink, faucet and toilet. The backyard was observed with perimeter fencing, outdoor play equipment, and additional age appropriate toys. LPA did not observe the following
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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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Document Has Been Signed on 12/13/2023 12:31 PM - It Cannot Be Edited


Created By: Randy Derraco On 12/13/2023 at 12:02 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: 198400286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not provide a crib or a play yard for each infant in care which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 12/26/2023
Plan of Correction
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Licensee states she will order a crib/playpen and send LPA a picture via email.
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
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Based on observation, interview and record review, the licensee did not maintain documentation of the required immunizations for her assistant which poses a potential health, safety and/or personal rights risk to persons in care.
POC Due Date: 12/26/2023
Plan of Correction
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Licensee states she will send LPA a copy of the immunzation records for her assistant by email.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023


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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 198400286
VISIT DATE: 12/13/2023
NARRATIVE
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items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. No bodies of water were observed in the back yard play area. Per licensee, she has a pet dog and cat. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Individuals who reside in the home were noted and discussed. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety,
comfort, and cleanliness. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. LPA observed a wall heater to be barricaded in the day care area. Licensee states that there are no firearms stored in the home. The licensee understands that storage areas for poisons must be locked, not just inaccessible. The valve on the required 2A-10BC fire extinguisher indicates fully charged and was serviced on 01/24/23, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

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.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 09/2024. LPA observed that the Licensee and assistant do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. During file review, LPA did not observe immunization records for assistant. LPA advised
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: 198400286
VISIT DATE: 12/13/2023
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licensee that a citation under Health and Safety Code (HSC) section 1597.622(c) will be issued. Children’s records were reviewed, including emergency information and were observed to be complete. A current children’s roster was available for review.

Incidental Medical Services (IMS):
IMS was discussed with licensee. 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 to access forms, regulations and quarterly updates online at: www.cdss.ca.gov. LPA also discussed and provided the following documents:
-PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect:
-LIC 311D - Forms to Keep in you Family Childcare Home
-Infant Sleep Chart

The following deficiencies listed on the attached LIC 809 (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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Chrystal Moore.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
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