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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400520
Report Date: 08/27/2024
Date Signed: 08/27/2024 01:24:07 PM

Document Has Been Signed on 08/27/2024 01:24 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:DAVID FAMILY CHILD CAREFACILITY NUMBER:
198400520
ADMINISTRATOR/
DIRECTOR:		DAVID, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 213-2090
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
08/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:DAVID, MICHELLE / LICENSEETIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) LPA Calderon arrived to the facility and met with Licensee Michelle David, who gave LPA a tour of the facility. The purpose of the inspection was to conduct a complaint inspection due to LPAs observations and staff interview, LPAs conducted a Case Management inspection.

The following was observed:
  • At 11:20am LPA Calderon observed a total of 9 children and 1 staff (Licensee) present and at 11:40am assistant staff arrived at the facility to provide assistance.
  • LPA observed 9 children at 11:20am with 1 staff and 3 children were infants.

LPA provided Licensee with Staffing Ratio and Capacity Regulation - 102416.5 and informed Licensee when no assistant present facility must follow Small Family Child Care Home.

The following deficiencies listed on the attached LIC 809-D (deficiency page) are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1 and Section CCR & H&S.



A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

An exit interview was conducted with Licensee Michelle David Appeal Rights and Notice of Site visit was given.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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 2
Document Has Been Signed on 08/27/2024 01:24 PM - It Cannot Be Edited


Created By: Ashley Calderon On 08/27/2024 at 12:51 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: DAVID FAMILY CHILD CARE
FACILITY NUMBER: 198400520

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2024
Section Cited
CCR
102416.5(e)

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10216.5(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).


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Licensee called assistant to see her return status ETA. At 11:40am Staff Assistant Arrived at the facility.
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This requirement was not met as evidence by:
LPA Calderon observed 9 children total- 3 infants and 6 day care children with 1 adult staff (Licensee). No assistant present, per Licensee assistant stepped out for a Dr appt.
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Type A
08/28/2024
Section Cited
HSC1597.44(b)

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Small family day care homes; number of children: 1597.44(b) A small family...home may provide care for more than 6 & up to 8 children, w/ out an additional adult attendant, if all of the following conditions are met...
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Licensee called assistant to see her return status ETA. At 11:40am Staff Assistant Arrived at the facility.
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(b) No more than two infants are cared for during any time when more than six children are cared for.

This requirement was not met as evidence by: LPA Caldeorn observing one staff and 9 children (3 were infants)
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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:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2024


LIC809 (FAS) - (06/04)
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