198400389-7-13-2021-54-CC-DGIS-C4VT9S-20210713143226

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400389
Report Date: 04/07/2021
Date Signed: 07/13/2021 02:32:55 PM

Document Has Been Signed on 07/13/2021 02:32 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:	HAWK FAMILY CHILD CARE		FACILITY NUMBER:	198400389
ADMINISTRATOR:	HAWK, EBONY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 603-9694
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ebony Hawk, applicant		TIME COMPLETED:	02:00 PM

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This was a pre-licensing inspection conducted on 4/7/2021 at 1:00 PM by Denise Gibbs, Licensing Program Analyst (LPA). Due to COVID-19 and precautionary measures, this pre-licensing inspection was conducted with Ebony Hawk, applicant via a tele-inspection by use of Facetime.

Individuals residing in the home have been discussed and noted. The applicant is requesting a large family childcare home license. Per applicant, operation hours will be Sunday - Saturday, 23.5 hours a day. Applicant states that they will care for children Infants to school-age.

During this tele-inspection the applicant took LPA on a tour of the home and the following was noted:

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two-story home that consists of three bedrooms, 3.5 bathrooms, Living Room, Dining Room, Kitchen, Laundry Area, Front yard and backyard (fenced).

Main care areas include Dining Room one room upstairs and back yard. Parents will enter the facility through a gate on the side of the home.

Off limit areas include, two bedrooms and three bathrooms on the second floor and the living room on the first floor made inaccessible with child safety gates. Stairs are made inaccessible using a safety gate. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Outdoor play area is located in the back yard. LPA observed that the yard is fenced and free of hazards. LPA observed shade and age appropriate toys and material outdoors.

Areas that will be used by children were inspected for safety, comfort, cleanliness. LPA observed operable -------------PAGE 1

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HAWK FAMILY CHILD CARE	FACILITY NUMBER: 198400389
	VISIT DATE: 04/07/2021

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telephone service, ventilation and heating (central). Detergents, cleaning compounds and hazardous items that can pose a danger to children are made inaccessible in a closet on a high shelf and in the kitchen on a high shelf. The applicant was advised that any poisons must be locked, not just inaccessible. The children's bathroom was observed to be free of hazards.

There are age appropriate toys and material available for children. Parent board is visible in the main care area with required postings. Children will nap on cots in the main care area. Applicant does plan on enrolling infants 0-24 months.

Infant Care: LPA informed applicant of the new Safe sleep regulation and provided PIN 20-24-CCP for when applicant is ready to enroll infants. The applicant states the following as a supervision plan for infants: infants will sleep in playpens in the main bedroom upstairs. infants will be supervised by one of the three staff at all times. LPA observed two playpens. Applicant is aware that one playpen/crib is needed for each infant. LPA provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Per applicant there are no pets, there are no firearms or weapons stored in the home and there are no bodies of water. LPA did not observe any of the above items.

LPA observed that the Applicant has a 2A10 BC fire extinguisher in the home, purchase tag 3/24/2021. Smoke and carbon monoxide detector were tested and are operable.

The applicant states that they will provide food for children in care. Any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated.

The applicant has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training and Pediatric First Aid and CPR. Applicant has proof of required immunization's. Assistants have required training's and immunization's. There are first aid supplies available.

LPA Provided COVID-19 Technical Assistance by emailing applicant COVID-19 resources and self-assessment prior to visit. LPA discussed self-assessment and answered question regarding COVID-19 procedures. --------------------PAGE 2

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HAWK FAMILY CHILD CARE	FACILITY NUMBER: 198400389
	VISIT DATE: 04/07/2021

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Essential Protective Equipment and Supplies- Staff and children (24 months and older) will wear facial coverings throughout the day, excluding meal and nap times (children). Applicant has a contact-less thermometer, disposable gloves, hand sanitizer and disinfectant cleaning supplies in the home on a cart which can be rolled inside and out for drop off and pick up.
Cleaning- Per applicant, high touched areas, bathroom and toys will be disinfected daily or as needed.
Hygiene- Per applicant children will be given hand sanitizer upon entering the home and wash their hands for at least 20 seconds throughout the day. Children will have individual cubbies for their personal belongings. The isolation area for a sick child waiting to be picked up will be in the upstairs infant nap room, the sick child will use one of the bathrooms upstairs if needed.
Arrival Procedures- Per applicant parents will drop off/pick up at the backdoor. Staff will do daily temperature checks and health screening at the front door, as parents will not be allowed to enter the facility. COVID-19 posters and resources are posted in the front entrance accessible to parents. Parents will be made aware of the COVID-19 policies and exclusion procedures in writing. Parents are aware that is they go out of town or participate in a large gathering over the weekend they have to quarantine for 10 days before returning to the facility.
Group Size- Applicant has three staff and three areas children can play in. If smaller group sizes are needed, they can utilize all areas. Applicant has a plan to utilize multiple tables for activities and meals for social distancing.

Incidental Medical Services (IMS):
This facility may provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

Applicant is requesting a large family child care. Fire clearance was approved on 3/31/21.
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HAWK FAMILY CHILD CARE	FACILITY NUMBER: 198400389
	VISIT DATE: 04/07/2021

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A large family childcare license may be granted upon Licensing Program Manager (LPM) Approval. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

Exit interview was conducted with Ebony Hawk, applicant via tele-inspection by use of Facetime. This report will be sent to the Applicant via email with a read receipt or confirmation of email, which will act as the Applicants signature.
--------------------------PAGE 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

LIC809 (FAS) - (06/04)

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