197404915-12-12-2023-30-CC-LPHS-CYFUVB-20231212145451

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197404915
Report Date: 12/12/2023
Date Signed: 12/12/2023 02:55:03 PM

Document Has Been Signed on 12/12/2023 02:55 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:	WORTHEN FAMILY CHILD CARE		FACILITY NUMBER:	197404915
ADMINISTRATOR:	LISA WORTHEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 447-8830
CITY:	VENICE	STATE: CA	ZIP CODE:	90291
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	12/12/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	LISA WORTHEN, LICENSEE		TIME COMPLETED:	03:15 PM

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On 12/12/2023 Licensing Program Analyst (LPA), Loyce Phillips conducted an unannounced Required Inspection and was met by Licensee, Lisa Worthen. LPA observed 5 children in care. Days and hours of operation are Monday through Thursday 8:00am to 5:00pm and Friday 9:00am to 4:00pm.

LPA toured the home inside and outside. This is 3 bedroom, 1 bathroom, living room, dining area, kitchen, laundry room and carport area. The home has a garage area with a bathroom inside that has been converted into a play room. LPA reminded Licensee that eating, sleeping and toileting are not allowed in the garage area.

The areas that are accessible to children: Living room, bathroom, dining area, kitchen, bedroom #3 (Changing and Napping room).Children have access to the back yard area, extended backyard and garage for active play.

The areas that is off limits to children: Bedrooms #1, #2, bathroom located in garage and storage unit and carport area. Bedrooms are made inaccessible.

No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible to children. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition stored on the premises.

There is a full charged fire extinguisher located in the kitchen. The facility has a working smoke detectors and carbon monoxide detector, inside the home. The facility has adequate heating and ventilation for safety and comfort. There are no stairs in the home. LPA observed age appropriate safe toys, materials and play equipment. The home has working telephone service and LPA confirmed the phone number is (310) 447-8830. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Capacity as specified on the license is being maintained. 809-C

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WORTHEN FAMILY CHILD CARE	FACILITY NUMBER: 197404915
	VISIT DATE: 12/12/2023

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Licensee’s pediatric CPR/First Aid was completed on 7/10/2023. Mandated Reporter Training expired.

This facility does not provide Incidental Medical Services – IMS. For IMS information see PIN 22-02-CCP. 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-carecenters/.

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.

Safe Sleep - 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-andresources/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.

LPA discussed with Licensee, LIC 9227 Individual Infant Sleep Plan. Infant's sleep environment and how to complete an infant sleeping log.

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. 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.

809-C

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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: WORTHEN FAMILY CHILD CARE	FACILITY NUMBER: 197404915
	VISIT DATE: 12/12/2023

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MyChildCarePlan.org – 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies are cited. Advisories discussed with Licensee.

An exit interview was conducted, a copy of this report was read and provided to the Licensee. This report shall me made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/12/2023 02:55 PM - It Cannot Be Edited

Created By: Loyce Phillips On 12/12/2023 at 02:01 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WORTHEN FAMILY CHILD CARE	FACILITY NUMBER: 197404915
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/12/2023

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 4 employees are missing mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/22/2023
	Plan of Correction
1 2 3 4	Licensee and staff will complete Mandated reporter training and send proof of completion by POC date.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in 4 out of 4 employees are missing immunization on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/22/2023
	Plan of Correction
1 2 3 4	Licensee and staff will update their files with immunization and send proof 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:

Karren Starks

LICENSING EVALUATOR NAME:

Loyce Phillips

LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

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