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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806024
Report Date: 07/11/2024
Date Signed: 07/11/2024 03:40:32 PM

Document Has Been Signed on 07/11/2024 03:40 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:GOOSBY FAMILY CHILD CAREFACILITY NUMBER:
191806024
ADMINISTRATOR/
DIRECTOR:		GOOSBY, OLLIE MAEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 303-1521
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 12TOTAL ENROLLED CHILDREN: 5CENSUS: 2DATE:
07/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Ollie Mae GoosbyTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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On 7/11/2024 at 11:30 AM/PM Licensing Program Analysts (LPAs) Claudia Kam and Andrea Carter conducted an Unannounced Required 1 year Annual inspection to the above facility. LPAs disclosed the purpose of the inspection and met with Licensee, Ollie Mae Goosby who guided the LPAs on a tour of the facility.

There are 3 adults living in the home. All adults in the home were found to have criminal record clearance. There were 2 day care children present during today’s inspection. Licensee states that there are currently 5 children enrolled. The children's roster was reviewed and is current. Licensee reports that the facility’s hours of operation are 6:00 AM to 9:00 PM, Monday thru Sunday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Per disaster drill log, the last drill was conducted on 6/19/24.

This is a two story home which consists of five bedrooms and three bathroom, kitchen, living room, dining room, den, and front and backyard. LPAs observed a fire place in the home that is barricaded by a gate in the main care area. Areas used by the children include the den, dining room, downstairs bathroom, and backyard. Living room will be used for isolation of sick children. Per Licensee, areas off limits to children and parents include 5 bedrooms and 2 bathrooms upstairs, kitchen, and living room when children are not isolating. LPAs observed that there is a safety gate at the entry of the living room, bottom and top of staircase. In addition there are additional safety gates at the entry to the kitchen, and in the dining room preventing access to the living room. The bathroom has a gate separating it from the laundry room making it inaccessible to children in care at time of inspection. Per licensee, in addition to the safety gates to the second floor the off limit bedrooms are locked during operating hours making them inaccessible to 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. Main Care Area for day care children will be the den. Main Care Area is located in the front of the home and equipped with age

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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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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: GOOSBY FAMILY CHILD CARE
FACILITY NUMBER: 191806024
VISIT DATE: 07/11/2024
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appropriate toys, books, blocks, child size tables with chairs, chid size couches, play kitchen for dramatic play, and a wall mounted tv. LPAs observed an A/C wall unit and a ceiling fan in every room of the home.
Dining room is located to the right of the day care area and consist of a dining room table and 6 chairs. There is a working telephone maintained in the home.

Per licensee, the children will have access to backyard for outside play. LPAs observed yard has grass and adequate perimeter fencing through-out the property. Licensee has a gazebo for shade, age appropriate scooters, and water tables for water play. LPAs observed backyard is a large open area for play and free of loose and sharp parts available for the children in the yard and all trees, shrubs, and plants are maintained.

The valve on the required 2A 10BC fire extinguisher indicates fully charged, reflects service date of 10/2/23. LPAs checked Smoke and carbon monoxide detectors are in operable condition at time of inspection. LPAs observed First Aid kit kept on floor in storage container in Main Care Area and was inventoried for necessary supplies .Hazardous items including poisonous cleaning compounds were stored and locked in the kitchen and bathroom making them inaccessible to children.
Licensee provided proof of immunization against influenza, pertussis, and measles during today’s inspection.

—CPR Card valid until: 5/2025
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPAs did not observe any bodies of water around the premises at time of inspection. Per licensee, they provide food for children in care. Food preparation area was toured and found in compliance for safety, cleanliness, and proper storage.

The following were discussed:



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GOOSBY FAMILY CHILD CARE
FACILITY NUMBER: 191806024
VISIT DATE: 07/11/2024
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For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee Mrs. Goosby 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.

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. LPAs 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.



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: https://www.ada.gov/resources/child-care-centers/.

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

During the exit interview, the Licensee Ollie Mae Goosby, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS on 7/9/2024.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GOOSBY FAMILY CHILD CARE
FACILITY NUMBER: 191806024
VISIT DATE: 07/11/2024
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 Based on this information the following deficiencies on the LIC 809 D are being cited today 7/11/2024.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Ollie Mae Goosby.








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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2024 03:40 PM - It Cannot Be Edited


Created By: Claudia Kam On 07/11/2024 at 01:47 PM
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: GOOSBY FAMILY CHILD CARE
FACILITY NUMBER: 191806024

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2024
Plan of Correction
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Licensee will complete mandatory reporter training and submit certificate in 30 days 8/11/24
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:Denise Gibbs
LICENSING EVALUATOR NAME:Claudia Kam
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024


LIC809 (FAS) - (06/04)
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