Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415189
Report Date: 08/21/2019
Date Signed: 08/21/2019 03:59:38 PM

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:MATTHEWS FAMILY CHILD CAREFACILITY NUMBER:
197415189
ADMINISTRATOR:MATTHEWS, SHAMECKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 734-3763
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:12CENSUS: DATE:
08/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Shamecka Matthews, LicenseeTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced annual random inspection to the above facility. LPA met with Shamecka Matthews, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was William Matthews, Licensee’s Assistant. Per Licensee, there are 2 children that are currently enrolled. A current children’s roster was available for review. There were 2 children present upon arrival.

This is a one-story home which consists of 3 bedrooms, 1 1/2 bathrooms, kitchen, dining room, living room, front yard and backyard (fenced). Main care is provided in the dining room, back bedroom and backyard. The children use the bathroom located in the back bedroom. LPA observed that there is a fireplace in the dinning room and is barricaded. Per Licensee, areas off limits to children and parents include: 2 bedroom, 1 bathroom, laundry room (used as walkway to backyard). The licensee provides food for children in care. Hours of operation are Mon-Fri 6am-6pm.

The licensee states that 2 adults currently live in the home. Per Licensee, she currently has one assistant. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms or weapons stored in the home.

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 landline and cellphone that is used at the facility during operation hours. There is ventilation and heating (central).

The following was observed and reviewed during this inspection:
Detergents, cleaning compounds, medications, and other items which could pose a danger to children ------------------Page 1
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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 5
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: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 197415189
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2019
Section Cited
CCR
102417(g)(1)
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Operation of a Family Child Care Home
The home shall contain a fire extinguisher which meet standards established by the State Fire Marshal.
This requirement was not met by licensee failing to provide proof of purchase or service tag.
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Per Licensee,
She will purchase a new fire extinguisher and email a copy of receipt to LPA by POC date 9/20/19.
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This poses an immediate health and safety risk to children in care.
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Type B
09/20/2019
Section Cited
HSC
1596.7995
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Employees or volunteers at day care center; immunization requirements; records; exemptions
Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against
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Per licensee,
she and her assistant will go to the doctor and email proof of immunizations to LPA by POc date 9/20/19.
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influenza, pertussis, and measles.
This requirement was not met by licensee failing to provide proof of all immunizations for staff #1 and staff#2
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 197415189
VISIT DATE: 08/21/2019
NARRATIVE
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were observed to be inaccessible to children. Poisons are locked in a cabinet under the kitchen sink. The restroom that children use was observed to be clean and free of hazards.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. Licensee could not provide a purchase receipt or service tag. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. Children nap on mats in the main care area. Infant pack n play is visible in main care area and are free of hazards.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. There are no pools or spas, or other bodies of water. The are no pets on the premises.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's and assistant's Pediatric First Aid and CPR expires on 4/2021. There are first aid supplies available.

Children’s records were reviewed, including emergency information but were observed to be incomplete.

The licensee and assistant do not have proof of immunization against influenza, pertussis, and measles. LPA observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA did not observe Mandated Reporter Training for assistant.

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 8/2019.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. ------Page 2
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 197415189
VISIT DATE: 08/21/2019
NARRATIVE
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LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS, updated Parent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) and Never Shake a Baby pamphlet. LPA also consulted and explained Child Abuse Reporting.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. 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 on line at: www.ccld.ca.gov.

Based on the LPA’s observations and records review, 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.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Shamecka Williams, Licensee, Appeal Rights were discussed and provided. -----Page 3
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER: 197415189
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2019
Section Cited
CCR
1024219(a)
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Child's Records
The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). (Notification of Parents’ Rights, LIC 995A)
This requiement was not mey by licensee failing to provide parents rights forms.
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Per licensee,
she will have parents sign a new form and email a copy to LPA by POC date 9/20/19
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For Child #1 and Child #2. This poses an immediate health and safety risk to children in care.
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Type B
09/20/2019
Section Cited
HSC
1596.8662(3)
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On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years following the date on
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Per licensee,
he will take the training and a copy of certificate will be emailed to LPA by POC date 9/2019
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which he or she completed the initial mandated reporter training.
This requirement was not met as evidenced by licensee failing to provide certificate of complettion of mandated reporter training (AB1207) for staff #2. This poses a potential health and safety risk to children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5