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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400770
Report Date: 04/25/2023
Date Signed: 04/25/2023 03:33:50 PM

Document Has Been Signed on 04/25/2023 03:33 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:LEWIS FAMILY CHILD CAREFACILITY NUMBER:
198400770
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Keahna LewisTIME COMPLETED:
03:48 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
Licensing Program Analyst (LPA) Warren Birks conducted a pre-licensing inspection. LPA Birks met with Applicant Keahna Lewis who guided analyst on a tour of facility. The applicant is requesting a Small Family Child Care license (with a capacity of six to eight children). Applicant Lewis indicated that she will care for children ages zero (0) to 12 years old and will operate from Monday-Friday 6:30am to 6:30pm. An Entrance Checklist was provided and all individuals residing in the home were notated.

All areas of the facility sketch were inspected. This is a one story home consisting of three bedrooms, two bathrooms, kitchen, living room, garage, front and back yard. Primary care will take place in the family room and occasionally the living room. LPA advised applicant that since the kitchen is accessible to make sure that chemicals, knives and any other kitchen hazards remain inaccessible to children in care.



Areas used by children include: Living room, Den, one bathroom and backyard.
Areas off limits include: three bedrooms, garage, and one bathroom.

Per applicant, the children will use the bathroom located in the hallway and off limit rooms will be made inaccessible by door locks. LPA inspected all areas used by children for safety, comfort, cleanliness, telephone service, ventilation and heating. The applicant was advised that any poisons must be locked with a key or combination lock. Applicant will keep all chemicals inaccessible to children. Note: LPA observed the play areas have age appropriate toys available for children. Applicant will need to provide evidence of sleeping equipment for infants. Applicant indicated she will send photos later.

The backyard is surrounded by fencing over 5 feet high (including a gate preventing vehicles from accessing the backyard driveway) where children play. Applicant indicated that no vehicles will park in the back yard. LPA also observed a five and 1/2 foot gate in the backyard driveway with barbed wire on top. LPA informed applicant that LPA will conduct more analysis/advice and get back to her regarding possible removal.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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 3
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: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 198400770
VISIT DATE: 04/25/2023
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
 The applicant understands that licensing staff may have access to off-limit areas during inspection visits if necessary. Per applicant, there are no firearms, weapons or bodies of water on the premises and none were observed. The applicant has no pets. LPA advised applicant to provide additional supervision if she ever has pets (as animals can be unpredictable around children). The applicant was informed items such as medicine, toothpaste, nail polish, hand sanitizer, cleaners, bleach and similar items must always remain inaccessible.

The valve on the 2A10BC fire extinguisher indicates fully charged and is due for service or replacement on or before April 2, 2024 (annual service is required or a new extinguisher must be purchased every year). LPA observed and tested a smoke and carbon monoxide detectors in the dining room and hallway and they were in operable condition.

Applicant Lewis states that she and parents will provide food for children in care and she will have back up food/snacks if necessary. LPA informed applicant to ensure that food brought from home is labeled with child’s name and properly stored or refrigerated.

The applicant has completed the required Health and Safety Training, Nutrition & Lead Training and Pediatric First Aid and CPR which expires 05/25/2023. LPA observed first aid supplies available. Mandated Reporter training is due February 18, 2025.

Applicant was reminded of all the terms and conditions noted on the LIC 279 – Application of a Family Child Care Home that applicant signed and agreed to.

Applicant states that they will care for infants. LPA advised the applicant to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. The applicant states the following is a supervision plan for infants: Applicant states that infants will sleep in a separate room and will provide supervision sometimes directly and/or document 15 minute checks. LPA emailed applicant a copy PIN 20-24-CCP and LIC 9227 to Applicant. LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage:

https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, 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.


SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 198400770
VISIT DATE: 04/25/2023
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
Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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 applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. Based on documentation and inspection, the applicant will be approved for a Small Family Child Care License once the following is completed:

1. Provide evidence of infant napping equipment. 2. Install cover on outdoor AC to prevent access to fan. 3. LPA will provide additional input on barbed wire fence.

Note: Applicant will contact the Department at a later date if she chooses to provide care in the garage or convert the garage to an additional dwelling unit. LPA informed applicant that no eating or sleeping can take place in the garage unless it has a permit as a liveable space. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. Exit interview was conducted with Applicant Lewis. This report along with appeal rights were provided.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3