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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404915
Report Date: 03/26/2025
Date Signed: 03/26/2025 04:52:56 PM

Document Has Been Signed on 03/26/2025 04:52 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:WORTHEN FAMILY CHILD CAREFACILITY NUMBER:
197404915
ADMINISTRATOR/
DIRECTOR:		LISA WORTHENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 447-8830
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
03/26/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:28 AM
MET WITH:Lisa WorthenTIME VISIT/
INSPECTION COMPLETED:
03:19 PM
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On 3/26/2025 Licensing Program Analyst (LPA), Ranita Richmond and Chartrice Johnson conducted an unannounced Case Management Deficiencies visit and was met by Licensee, Lisa Worthen. Adult resident Leeka, Monti was home in the residence during the inspection. LPA observed 6 children in care being supervised and cared for appropriately by 3 adults. 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. The home is a 3 bedroom, 1 bathroom home that includes, living room, dining area, kitchen, laundry room, fenced backyard, carport,and garage area with a bathroom inside that has been converted into a play room. LPA reminded Licensee that eating, sleeping and toileting should take place inside the main house living quarters and is not allowed in the garage area.

The ON LIMITS Areas are: Living room, bathroom, dining area, kitchen, bedroom #3 (Changing and Napping room). fenced back yard area, extended backyard and converted garage for active play.

The OFF LIMITS Areas: Bedrooms #1, #2, bathroom located in converted garage, storage unit and carport area. Bedrooms are made inaccessible by locked doors.

During walk through LPA observed one infant sleeping in bedroom #3 with the door closed (sleeping on their stomach). LPA requested infant sleep chart. Infant sleep charts not completed as the infant sleeps. Per assistant, infant sleep chart is completed at the end of each day and stored on computer. LPA requested for assistant to print infant sleep charts. LPA reviewed the infant sleep logs. Infant sleep logs missing documentation. Type B citation issued. See LIC 809D. LPA observed medications in the kitchen on the counter, in the hallway on an open shelf, and in the bathroom on the counter, medicine cabinet, and under sink in cabinets, accessible to children in care. LPA observed knives in the kitchen on the counter inside a dish rack accessible to children in care. Type B citation cited. See LIC 809D. LPA observed detergents, cleaning solutions, disinfectants, and health & hygiene and beauty supplies in the laundry room, kitchen counter, and bathroom where they are accessible to children in care. Type B citations cited. See LIC 809D.

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NAME OF LICENSING PROGRAM MANAGER: Claudia Escobedo
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WORTHEN FAMILY CHILD CARE
FACILITY NUMBER: 197404915
VISIT DATE: 03/26/2025
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LPA reviewed Guardian Background check system and observed that 4 of the 5 adults in the home during the visit are fingerprint cleared. LPA advised licensee and S1 (who has been employed at the family daycare home since March 2024), that S1 does not have a fingerprint clearance and needs to leave the home immediately. S1 is not to return to the home until fingerprints are cleared. S1 was provided a live scan application to complete fingerprint clearance. Type A citation cited. Civil penalty assessed. See LIC 809D. See LIC 421BG. Per licensee, a new deck was built in fenced backyard. Deck construction began in October 2024 and was completed in January 2025. The licensee did not notify the Department of the dock being built. Type B citation cited. See LIC 809D.


LPA Ranita Richmond informed licensee Lisa Worthen that this report dated 3/26/25 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Ranita Richmond informed the licensee Lisa Worthen to provide a copy of this licensing report dated 3/26/25 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Four type B citation cited per Title 22 Regulations and Health and Safety Codes.


An exit interview was conducted, a copy of this report and appeal rights was read and provided to licensee Lisa Worthen.

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NAME OF LICENSING PROGRAM MANAGER: Claudia Escobedo
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/26/2025 04:52 PM - It Cannot Be Edited


Created By: Ranita Richmond On 03/26/2025 at 12:54 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: 03/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
03/27/2025
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance
(d) All individuals subject to a criminal record review...shall prior to working...in a licensed facility: (1)Obtain a California clearance or a criminal record exemption...This requirement is not met as evidenced by:
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S1 was asked to immediately leave the family daycare home. S1 will not be permitted to work or volunteer in the family daycare home until fingerprint clearance is complete. S1 was provided a live scan application to complete livescan.
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LPA reviewed Guardian Background check system and observed that 4 of the 5 adults in the home during the visit are fingerprint cleared. S1 was working in the family daycare home without a fingerprint clearance.
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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.
Claudia Escobedo
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/26/2025 04:52 PM - It Cannot Be Edited


Created By: Ranita Richmond On 03/26/2025 at 01:07 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: 03/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
04/09/2025
Section Cited
CCR
102416.3(a)(4)

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102416.3 Alterations to Existing Buildings or Grounds(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department...(4) Construction of exterior decks or porches.This requirement is not met as evidenced by:
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Licensee was informed that prior to making any alteration to the family childcare home that the Department will be notified. Licensee will write out and submit for review by the department a written plan as to how daycare will proceed with alterations to the existing building or grounds in the future.
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Based on interview with licensee, LPA was advised that new deck was built in the fenced backyard. The construction began in approximately October 2024 and ended in January 2025.
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Request Denied
Type B
04/09/2025
Section Cited
CCR102417(g)(4)

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102417 Operation of a Family Child Care Home(g) The home shall be free from...conditions which might endanger ...:(4) ...detergents, cleaning compounds, medicines,... shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
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Licensee will make disinfectants, cleaning compounds, detergents, etc. inaccesible to children in care by placing and storing them in off limits areas, on high shelves, or in locked area at all times.
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LPA observed detergents, cleaning solutions, disinfectants, and health & hygiene, and beauty supplies in the laundry room, on kitchen counter, and in bathroom on sink and in cabinets where they are accessible to children in care.
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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.
Claudia Escobedo
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/26/2025 04:52 PM - It Cannot Be Edited


Created By: Ranita Richmond On 03/26/2025 at 01:28 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: 03/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
04/09/2025
Section Cited
CCR
102417(g)(4)(A)

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102417 Operation of a Family Child Care Home(g) The home shall be free from...conditions which might endanger ...:(4) ...items which could pose a danger,...shall be stored...(A) Storage areas for...weapons shall be locked. This requirement is not met as evidenced by:
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Licensee will remove, keep, and store dangerous weapons in a locked area at all times.
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LPA observed knives in the kitchen on the counter inside a dish rack accessible to children in care.
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Request Denied
Type B
04/09/2025
Section Cited
CCR102425(j)(2)(B)

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102425 Infant Safe Sleep(j) The provider shall supervise infants while they are sleeping... (2) The provider shall check and document the following:(B) Signs of distress .... This requirement is not met as evidenced by:
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LIcensee will complete infant sleep chart in real time daily as the infants sleep. Licensee will include on infant sleep chart the infant's name, date of birth, waiver, date, staff initials, time, position, and comments. Licensee will create a copy of infant sleep chart for review by the Department.
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LPA requested infant sleep chart. Infant sleep charts not completed as the infant sleeps in real time. Per assistant, infant sleep chart is completed at the end of each week and stored on computer. LPA observed sleeping infant at 1:03p, 1:18p, 1:33pm. No sleep chart documentation completed.
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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.
Claudia Escobedo
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2025


LIC809 (FAS) - (06/04)
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