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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191594940
Report Date: 04/27/2023
Date Signed: 04/27/2023 12:36:40 PM

Document Has Been Signed on 04/27/2023 12:36 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:COLBERT FAMILY DAY CAREFACILITY NUMBER:
191594940
ADMINISTRATOR:COLBERT, LEE ETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 213-9767
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lee Etta Colbert, LicenseeTIME COMPLETED:
01:00 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
On 04/27/2023 at 9:18 AM, Licensing Program Analysts (LPAs) Katrina Chicote and Franchesca White conducted an Unannounced Required – 1 Year inspection to the above facility. Upon arrival, LPAs disclosed the purpose of the inspection and met with Licensee, Lee Etta Colbert, who guided the LPAs on a tour of the facility. Adults in the home were discussed and all have criminal record clearance. Also present was Licensee’s Assistant (A1) and Co-Licensee Hyacinth Thompson later joined inspection. There were two infants and five children, totaling seven day care children present during today’s inspection. Licensee states that there are currently eight children enrolled. The children's roster was reviewed and is current. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 03/2023.

This is a single-story home which consists of three bedrooms and two bathrooms, Kitchen, Living room, Dining Room, and Day Care Room. Areas used by the children include the Living Room (located upon entry of the home), Bedroom 1 (located to the right of the home), Bathroom 1 (located next to Bedroom 1), Dining Room (located through Living Room), and Day Care Room (located through doorway to the left). Per Licensee, off limit areas to children and families are Kitchen, Bedrooms 2 & 3, and Bathroom 2 which is located in Bedroom 2). Per Licensee, bedrooms are locked during operating hours, LPA observed doors to be locked. At 9:47 AM, LPAs observed Kitchen has not been made off limits to children in care at time of inspection. At 9:49 AM, LPAs observed knives and medicines in Kitchen accessible to children at time of inspection. Per Licensee, this area is off limits per Supervision and LPAs did not observe children enter Kitchen at time of inspection but LPA advised that off limits areas need to be made off limits. The Licensee was also advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. At 9:32 AM, LPAs observed
Report Continues - Page 1 of 4
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: COLBERT FAMILY DAY CARE
FACILITY NUMBER: 191594940
VISIT DATE: 04/27/2023
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
fireplace with gate and operable child safety lock and floor heater with a barrier in Living Room making these off limits to children in care. There is a working telephone maintained in the home. At 9:37 AM, LPAs observed Living Room to have large couch, TV hanging on wall, pack-n-play, infant seats, and child size chairs available for children in Living Room. Per Licensee, they provide food to children in care. At 9:40 AM, LPA observed Dining Room to have circular glass table with four chairs and a child size picnic table available for children eating. At 9:42 AM, LPA observed Day Care Room to have cots laid out with sheets at time of inspection, child size table and chairs, plastic play kitchen, art materials, and age appropriate toys well maintained at time of inspection. At 9:51 AM, LPA observed Bathroom 1 to have operable toilet and sink, adequate hand washing and toileting supplies, and general area safety and sanitation at time of inspection. At 9:53 AM, LPAs observed Bedroom 1 to have two pack-n-plays and four training toilets at time of inspection.

Per Licensee, the children will have access to backyard for outdoor play area which LPA observed to be accessible through backdoor in Day Care Room. At 9:54 AM, LPAs observed backyard has grass and adequate perimeter fencing through-out the yard. LPAs observed small plastic play slide, Little Tikes plastic basketball hoop available for the children in the backyard and all trees, shrubs, and plants are maintained. At 9:57 AM, LPAs observed a pool in the backyard that LPAs observed to be fenced off. LPAs observed a waiver posted at time of inspection in regards to Title 22 Regulation fencing requirements. LPAs observed waiver requirements were met at time of inspection.

Per Licensee, there are no pets and LPAs did not observe any pets at time of inspection. Licensee states isolation area for sick children is in Bedroom 1.

At 9:47 AM, LPAs observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with no service tag or proof of purchase receipt available at time of inspection. At 9:53 AM, LPAs tested dual smoke and carbon monoxide detectors and observed to be in operable condition. Per Licensee, First Aid kit is kept in the Day Care Room, LPAs observed First Aid kit and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR valid until 07/14/2023. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection for 2 of 3 staff present. The Licensee has taken the AB1207 Mandated Reporter Training on 05/15/2022 and observed 2 of 3 staff present having proof of completion.
Report Continues - Page 2 of 4
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: COLBERT FAMILY DAY CARE
FACILITY NUMBER: 191594940
VISIT DATE: 04/27/2023
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
Licensee states there are no firearms or weapons in the home, LPAs did not observe any firearms or weapons in the home of inspection.

The following were discussed:
Incidental Medical Services (IMS)
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

Licensee (or facility representative) was reminded that all adults 18 and over living or working in the home, 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.

NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.



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.

Report Continues - Page 3 of 4
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
Page: 3 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: COLBERT FAMILY DAY CARE
FACILITY NUMBER: 191594940
VISIT DATE: 04/27/2023
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
Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Based on this information, the following deficiencies on the attached LIC 809D 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 inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



Exit interview was conducted and report was reviewed with the Licensees, Lee Etta Colbert. and Hyacinth Thompson


Report Ends - Page 4 of 4
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 11
Document Has Been Signed on 04/27/2023 12:36 PM - It Cannot Be Edited


Created By: Katrina Chicote On 04/27/2023 at 11:54 AM
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: COLBERT FAMILY DAY CARE
FACILITY NUMBER: 191594940

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPAs observation and interview, Licensee did not observe fire extinguisher with service tag or receipt available. Licensee states she does not have receipt during inspection. This is a potential health, safety, and personal rights risk to children in care.
POC Due Date: 05/26/2023
Plan of Correction
1
2
3
4
Licensee states she will locate receipt as they state it was purchased within the year and provide proof to LPA via text by POC date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, A1 did not have proof of completion for AB1207 Mandated Reporter training at time of inspection. A1 states she has not taken the training. This is a potential health, safety, and personal rights risk to children in care.
POC Due Date: 05/26/2023
Plan of Correction
1
2
3
4
Licensee states she will have A1 take training and provide proof of completion to LPA via text by POC date.
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:Karen Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023


LIC809 (FAS) - (06/04)
Page: 5 of 11
Document Has Been Signed on 04/27/2023 12:36 PM - It Cannot Be Edited


Created By: Katrina Chicote On 04/27/2023 at 11:54 AM
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: COLBERT FAMILY DAY CARE
FACILITY NUMBER: 191594940

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, A1 did not have proof of immunization for TdaP, MMR, and Influenza (or written declination for this ONLY) at time of inspection. This is a potential health, safety, and personal rights risk to children in care.
POC Due Date: 05/26/2023
Plan of Correction
1
2
3
4
Licensee states she will obtain records for A1 and provide to LPA via text by POC date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Karen Chambers
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023


LIC809 (FAS) - (06/04)
Page: 6 of 11