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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412907
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:07:35 PM

Document Has Been Signed on 10/20/2022 02:07 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:TERRELL FAMILY CHILD CAREFACILITY NUMBER:
197412907
ADMINISTRATOR:TERRELL, JUDITH C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
3237571467
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 5DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Judith Terrell, LicenseeTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA), Shandra Powell, conducted an unannounced Annual Required inspection on 10/20/2022. LPA met with Licensee, Judith Terrell. LPA observed six children in care three of which were infants. All Adults present, residing, working and/or volunteering in the home have a criminal record clearance or exemption and are associated to the facility.

PHYSICAL PLANT

This a one story home with three bedrooms, two 1/2 bathrooms, living room, dining room, kitchen, back porch/laundry room and detached garage. Per Licensee, no childcare is conducted in the detached garage and door is locked while children are outside. Bedroom #1 with bathroom and Bedroom #2, half bathroom ,kitchen and bathroom #1 are off-limit and made inaccessible by closed doors with child proof knobs and gate during operation hours. Bedroom #3 at the rear of the home Living Room and Dining Room (Den) are the main child care rooms which children in care utilize daily. LPA observed cribs and cots for napping located in Dining Room and Bedroom #3. Licensee stated the Living Room is used as an isolation area for children who become ill during care. Children in care utilize the bathroom in the hallway.

Hours of operation are Monday through Friday, 06:00 AM to 06:00 PM. Per Licensee, Breakfast, Lunch and Snacks are provided by Licensee. LPA advised Licensee that each infant bottles are to be labeled with the child's name and properly stored.
The outdoor play area is located in the the back yard of home and is fully fenced in and free from dangerous and hazardous conditions. LPA advised Licensee that children in care shall be supervised at all times.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TERRELL FAMILY CHILD CARE
FACILITY NUMBER: 197412907
VISIT DATE: 10/20/2022
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The home was inspected for safety, comfort and cleanliness. The home has working telephone service. The telephone number on file with the Department was confirmed and verified. All poisons, to include, detergents, cleaning compounds, medication and other hazardous materials are inaccessible to children in care. There is a fully charged fire extinguisher that is at least a 2A: 10BC in the home. LPA observed service tag on fire extinguisher which read Oct 2022. There is at least one working carbon monoxide detector and smoke detector in the home. There is also a first aid kit in the home. Centralized heat, air ventilation system are used as heating and cooling sources. LPA observed safe and age-appropriate toys and play equipment in the home. Per Licensee, there are no weapons, firearms or ammunition in the home. Licensee was informed if obtains, firearms and ammunition must be stored and locked separately. Per Licensee, there are no pools, spas, hot tubs, or other similar bodies of water on property; none were observed by LPA.

FACILITY RECORDS

LPA observed Licensee and Assistants current Pediatric CPR and First Aid cards. Licensee's Pediatric CPR and First Aid certification completed on 05/21/2022 . LPA observed Mandated Reporter training certificates for Licensee and Assistants; Licensee renewed Mandated Reporter training on 05/21/2022. LPA reminded Licensee that Licensee and staff are to renew Mandated Reporter training every two years online at: www.mandatedreporter.ca.

LPA observed a current facility roster during inspection with 10 children enrolled. LPA observed a monthly earthquake/fire drill during inspection, last drill conducted October 2022.

LPA reviewed facitiy and staff files during today's inspection and observered the following: Current Pediatric CPR and First Aid Certification,Crimina Record Statment (LIC508)
Employee Rights (LIC9052), Immunizations, TB Clearance, Statement Acknowledging (LIC 9180)
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TERRELL FAMILY CHILD CARE
FACILITY NUMBER: 197412907
VISIT DATE: 10/20/2022
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LPA reviewed children's files during today's inspection and observed the following: Children's Records: Immunization Records, LIC 700 (Identification and Emergency Information), LIC 627 (Consent for Emergency Medical Treatment), LIC 995A (Notification of Parents' Rights) . Licensee stated she has Home and Daycare Insurance.
The following was thoroughly discussed with Licensee:
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.

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.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TERRELL FAMILY CHILD CARE
FACILITY NUMBER: 197412907
VISIT DATE: 10/20/2022
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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates,
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. 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.


To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Judith Terrell, Licensee, including appeal rights.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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