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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402756
Report Date: 10/14/2021
Date Signed: 10/14/2021 02:45:17 PM

Document Has Been Signed on 10/14/2021 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:COLEMAN FAMILY CHILD CAREFACILITY NUMBER:
197402756
ADMINISTRATOR:CYNTHIA COLEMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 677-9737
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Cynthia ColemanTIME COMPLETED:
01:10 PM
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On 10/14/2021 Licensing Program Analyst (LPA),Stella Gutierrez conducted an unannounced Annual Required Inspection and was met by Licensee, Cynthia Coleman. Days and hours of operation are 24 Hours 7 Days per week. .

LPA toured the home inside and outside and a census was taken. An Entrance checklist (LIC 126) was provided to Licensee before today's inspection tour. Current facility sketch reviewed, and Licensee confirmed that the Den area which is the main care area, Bathroom off teh kitchen and outside concrete area are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of locks. There is a swimming pool on the premises. Swimming pool observed today to be inaccessible to the children in care. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The fireplace located in the family room is made inaccessible by a screen and will not be in use during day care hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (310) 677-9737

There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 08/08/2021. Licensee’s pediatric CPR/First Aid expires on 05/25/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Page 1 of 2

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: COLEMAN FAMILY CHILD CARE
FACILITY NUMBER: 197402756
VISIT DATE: 10/14/2021
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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Staff interview conducted at 12:30 PM .

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations no deficiencies are cited.


This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
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