198400845-11-3-2023-54-CC-RDEO-CX8THZ-20231103144535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400845
Report Date: 11/03/2023
Date Signed: 11/03/2023 02:45:43 PM

Document Has Been Signed on 11/03/2023 02:45 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:	JOHNSON FAMILY CHILD CARE		FACILITY NUMBER:	198400845
ADMINISTRATOR:	JOHNSON, AQUILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 454-6343
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 1	CENSUS: 1	DATE:	11/03/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Licensee - Aquila Johnson		TIME COMPLETED:	03:15 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) Randy Derraco conducted an announced pre-licensing inspection to the above mentioned address on 11/03/23 at 12:00 PM. LPA met with licensee, Aquila Johnson, who guided LPA on a tour of the home. LPA observed one adult and one child present during inspection. Individuals residing in the home have been noted and discussed. The licensee is requesting a capacity increase and an address change to her family childcare home license. Per licensee, operation hours will be Monday through Friday, 6AM - 11PM and Saturday 6AM-8PM. Licensee states that they will care for children 0 to 6 years. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home that consists of 3 bedrooms, 1 1/2 bathrooms, 2 living rooms, dining room/Kitchen, laundry area, garage, front yard and backyard (fenced). The off limit areas include 3 bedrooms, 1 bathroom, 1 living room, dining room/kitchen, and laundry area. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. Main care areas is located in the 2nd living. LPA observed age appropriate toys, wooden cubby shelves for toy storage, educational posters, 2 Cosco play pens, child sized tables, child sized chairs, 2 infant / toddler rockers, and a wall mounted television. A first aid kit was observed on a shelf next to the door. LPA observed a space on the wall of the main care area designated for required postings. The bathroom designated for children to use was observed with an operable sink, faucet and toilet. A tension gate was observed at the entrance of the kitchen making it inaccessible to children in care. The backyard has been designated for outdoor play. LPA observed perimeter fencing, age appropriate toys, and shade provided by a pop up tent. Per licensee, heat will be provided by electric heaters during the colder days. LPA observed an electric fan in the main care area. The front yard was observed with grass. Per licensee, she plans to use a slip and slide during the hot days in the front yard. Perimeter fencing was not observed in the front yard area. LPA advised licensee that children using the front yard must be supervised 100% of the time Areas that will be used by children were inspected for safety, comfort, cleanliness. LPA observed operable (page 1 of 3)

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 198400845
	VISIT DATE: 11/03/2023

NARRATIVE

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telephone service via land line, however licensee states she will be using a cell phone. Detergents, cleaning compounds and hazardous items that can pose a danger to children were observed on a shelf in the laundry area. Children in care will pass through the laundry area to access the bathroom. During the inspection, LPA observed licensee taking cleaning supplies and storing them in an elevated cabinet. The cabinet was observed with a latch lock. The licensee was advised that any poisons must be locked, not just inaccessible.

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.

Per licensee she does not own any pets, however she has a dog sitting service and the dog is kept caged in the off limits living room. Per licensee, there are no firearms or weapons stored in the home. LPA did not observe any bodies of water on the premises. LPA observed that the licensee has a 3A 40- BC fire extinguisher in the home, purchase receipt dated 07/16/23. Smoke and carbon monoxide detector were tested and are operable. The licensee 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 licensee has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training and Pediatric First Aid and CPR. Licensee has proof of required immunization's. Assistants have required training's and immunization's.

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
(page 2 of 3)

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 198400845
	VISIT DATE: 11/03/2023

NARRATIVE

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(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.cdss.ca.gov

Licensee is requesting a large family child care and an address change. Fire clearance was approved on 08/15/23

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

The following documents were provided to LPA during inspection:
-Updated LIC 279 - application
-Immunization records for resident and staff
-LIC 9108 for staff member
-LIC 9149 - Landlord consent form
-Completed lease agreement
-LIC 999 - Facility Sketch

Exit interview conducted and report was reviewed with the licensee Aquila Johnson

(page 3 of 3)

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

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