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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410750
Report Date: 08/22/2024
Date Signed: 08/22/2024 04:31:03 PM

Document Has Been Signed on 08/22/2024 04:31 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:HOLLAND FAMILY CHILD CAREFACILITY NUMBER:
197410750
ADMINISTRATOR:HOLLAND, MONA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 359-8384
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:MONA HOLLAND, LICENSEETIME COMPLETED:
03:00 PM
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On 08/22/2024, Licensing Program Analyst (LPA) Lisa Clayton made an unannounced visit to the Holland Family Child Care Home to conduct the Required 3-year inspection. LPA was greeted by Licensee Mona Holland. There were no children in care. Per Licensee the hours of operation are Monday through Friday, 24 hours. Licensee provides breakfast, lunch, water and juice – families will provide snacks.

LPA Clayton toured the home inside and outside for a Health and Safety inspection. The home has working telephone and LPA Clayton confirmed the number is (323) 359- 8384.

LPA Clayton confirmed that the single-family home consists of the following: living room, dining room, kitchen, 3 bedrooms, 1 ¾ bathrooms, laundry room, den, covered patio, attached garage, and fenced back yard with a storage shed.

The ON LIMIT AREAS are as follows: living room, dining room, kitchen, den (day care room), bathroom #2, laundry room, covered patio, and fenced back yard. The ISOLATION AREA will be in the living room.

The OFF-LIMIT AREAS are as follows: bedroom #1, bedroom #2, bedroom #3, bathroom #1, storage shed and attached garage, all of which are inaccessible to children in care by closed and/or locked doors and visual supervision.

Furniture and equipment are in good condition and free of sharp, loose, or pointed parts.

There are no pools, ponds or any other bodies of water on the premises. There are no firearms or ammunition on the premises.



The home has a fully charged 2A10BC fire extinguisher in the laundry room, a working carbon monoxide detector and working smoke detector in the laundry room, and a working smoke detector in the living room.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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 4
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: HOLLAND FAMILY CHILD CARE
FACILITY NUMBER: 197410750
VISIT DATE: 08/22/2024
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LPA Clayton provided licensee with an updated LIC 311D, and a licensee packet including the following documents:
· Children's files documents
· Facility file list
· Parent board documents
· Safe Sleep regulations, and a Sleep Log
· Disaster drills which includes the dates and times the drills were conducted, as required in Title 22 Regulations.

Licensee has not provided care since 2022. Licensee reported that her home flooded in December of 2022 and all of her children’s files were damaged in the flood. LPA Clayton reviewed the documents required for children’s files with Licensee Mona and reminded her of the requirement to be in compliance as they must contain current contact information for authorized representatives and/or relatives who can assume responsibility for the child, and signed Parent’s Rights.

Licensee has current CPR/First Aid certificate that expires in August 2025 and Mandated Reporter training that expires November 2025. Licensee is in compliance with immunizations required for childcare providers.

LPA Clayton licensee advised Licensee to access 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.


Incidental Medical Services (IMS) are not currently being provided. LPA Clayton provided licensee with an IMS Plan sample. Licensee is aware that an IMS plan is required to be submitted to the licensing office upon completion. 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 reminded Licensee of 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.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: HOLLAND FAMILY CHILD CARE
FACILITY NUMBER: 197410750
VISIT DATE: 08/22/2024
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Licensee has not provided care since 2022. Licensee reported that her home flooded in December of 2022 and all of her children’s files were damaged in the flood. LPA Clayton reviewed the documents required for children’s files with Licensee Mona and reminded her of the requirement to be in compliance as they must contain current contact information for authorized representatives and/or relatives who can assume responsibility for the child, and signed Parent’s Rights.

Licensee has current CPR/First Aid certificate that expires in August 2025 and Mandated Reporter training that expires November 2025. Licensee is in compliance with immunizations required for childcare providers.

LPA Clayton licensee advised Licensee to access 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.


Incidental Medical Services (IMS) are not currently being provided. LPA Clayton provided licensee with an IMS Plan sample. Licensee is aware that an IMS plan is required to be submitted to the licensing office upon completion. 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 reminded Licensee of 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: HOLLAND FAMILY CHILD CARE
FACILITY NUMBER: 197410750
VISIT DATE: 08/22/2024
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Licensee was informed 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&R) throughout California.


During the exit interview, Licensee Mona confirmed that there are no Registered Sex Offenders living in the home and LPA completed the RSO profile in FAS.

Licensee will forward a copy of the revised Disaster Plan and Facility sketch to LPA Clayton and the department via email, prior to providing care.

Per Title 22 Regulations and Health and Safety Codes, no deficiencies were cited today.

An exit interview was conducted, a copy of this report was read and provided to licensee Mona and will be 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: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
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