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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191608538
Report Date: 02/01/2024
Date Signed: 02/01/2024 01:01:13 PM

Document Has Been Signed on 02/01/2024 01:01 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BERG AND BERG FAMILY CHILD CAREFACILITY NUMBER:
191608538
ADMINISTRATOR:BERG, LILY AND MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 487-7697
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
02/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:MICHELLE BERG, LICENSEETIME COMPLETED:
01:30 PM
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On 02/01/2024 Licensing Program Analyst (LPA) Lisa Clayton conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION. LPA Clayton was greeted by licensee Michelle Berg. LPA Clayton observed 8 children in care, being supervised and cared for by licensee and her fingerprint cleared assistant. Hours of operation are Monday – Friday 7:30am – 5:30pm. Applicant will provide am/pm snacks and water.

The home was toured with the Licensee for a health and safety inspection.

LPA confirmed that home consists of the following: living room, dining room, kitchen, 2 bedrooms, 1 bathroom, family room (play area), detached garage, and fenced backyard.

Licensee has requested the following rooms be ON-LIMITS: the family room (main day care area), bedroom #2 (to access the bathroom only), bathroom, kitchen (for eating), and the fenced back yard. The ISOLATION AREA will be in the main day care room.

The licensee has requested the OFF-LIMIT AREAS are as follows: living room, dining room (currently being used as bedroom), bedroom #1, and detached garage all of which are inaccessible to children in care by child safety gates, closed and/or locked doors and visual supervision.

The home is neat and clean with heating and ventilation for safety and comfort. The FCCH has a working phone and LPA Clayton confirmed the number is 310-487-7706.

The home has a working carbon monoxide/smoke detector combo in the kitchen, a working smoke detector in the main day care area. LPA Clayton observed a fully charged 1:A10:BC Fire Extinguisher in the kitchen.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/01/2024 01:01 PM - It Cannot Be Edited


Created By: Lisa Clayton On 02/01/2024 at 11:55 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BERG AND BERG FAMILY CHILD CARE
FACILITY NUMBER: 191608538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Clayton record review the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/05/2024
Plan of Correction
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Licensee will ensure that all residents of the home, 18 year of age and older are fingerprint cleared. Licensee will provide LPA Clayton and the department with proof of LiveScan fingerprints for resident Carlos Escoto Marinez no later than 02/05/2024. Licensee is aware that until a fingerprint clearance is obtained, the above mentioned resident is not to be in the home.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karren Starks
LICENSING EVALUATOR NAME:Lisa Clayton
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BERG AND BERG FAMILY CHILD CARE
FACILITY NUMBER: 191608538
VISIT DATE: 02/01/2024
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Per licensee, there are no firearms in the home. There are no pools, ponds, spas or other bodies of water on the property. Any poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are made inaccessible to children in care.

LPA Clayton observed age-appropriate toys, books and furnishing and equipment that are in good condition, free of sharp, loose or pointed parts.



Licensees and her assistant have current CPR/First Aid certificates and are in compliance with the immunization law which pertains to day care providers.

LPA reviewed 5 children’s files and observed them to be in compliance as they contained current contact information for authorized representatives and/or relatives who can assume responsibility for the child, and authorization for medical treatment, signed Parent’s Rights.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and­resources/safesleep as an additional resource. LPA Clayton informed applicant of the importance of checking for recalled infant devices on the United States Consumer Products 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 the purchased equipment.



California Law requires Family Child Care Home applicants to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. Please report Telephone number changes and/or if you move from home.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BERG AND BERG FAMILY CHILD CARE
FACILITY NUMBER: 191608538
VISIT DATE: 02/01/2024
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LPA provided licensee with the updated LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

In addition, LPA Clayton reminded licensee of the following:


o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
o LPA showed the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

Licensee was advised of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

LPA Clayton provided Licensee with the following documents required for Childrens Files/records:

· LIC 9227 Individual Sleep Plan for infants 0 – 12 months

· Sleep Log Sample for infants 0 – 24 months

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BERG AND BERG FAMILY CHILD CARE
FACILITY NUMBER: 191608538
VISIT DATE: 02/01/2024
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Licensee is to provide an updated facility sketch and complete Mandated Reporter Training certificates for Child Care Providers no later than Monday February 5, 2024.

Licensee will provide proof of a 2A:10:BC Fire Extinguisher.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, Deficiencies and Technical Violations were cited (See LIC 809-D, and LIC 9102).



An exit interview was conducted, and report was reviewed and provided to Licensee Michelle Berg. A notice of site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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