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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415612
Report Date: 10/27/2022
Date Signed: 10/27/2022 05:10:12 PM

Document Has Been Signed on 10/27/2022 05:10 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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ALON FAMILY CHILD CAREFACILITY NUMBER:
197415612
ADMINISTRATOR:ALON, KERENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 888-2026
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Keren AlonTIME COMPLETED:
05:00 PM
NARRATIVE
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On 10/27/2022 at 2:05 pm Licensing Program Analyst (LPA), Deborah Lowe conducted an unannounced Annual Required Inspection and was met by Adult 1 (A1). Licensee, Keren Alon arrived at 2:15 pm. Days of operation are Monday – Friday 8:15 am – 4:00 pm. Present in the home during inspection was licensee, A1, Adult 2 (A2), Adult 3 (A3), and Adult 4 (A4).

LPA toured the home inside and outside. Per licensee care and supervision is primarily provided in the detached converted garage. LPA observed children eating snack outside at table and benches. At 2:20 pm LPA Lowe observed 9 children napping on mats in the converted garage. LPA Lowe observed the home with kitchen, 3 bedrooms, 2 bathroom and living room/dinning room. Kitchen was made off limits with the use of a child gate. Three bedrooms were made off limits with the use of locked doors. Fire place was observed with gate barrier.

LPA observed 3 dogs and 1 rabbit in the home. LPA reviewed vaccination records for dogs. Per Licensee dog are not permitted in areas children are present.

LPA Lowe observed the swimming pool with a black mesh pool fencing. LPA pulled and tugged on each of the post and fencing was observed to be secure. Pool gate does not have a designated entrance. Each panel of the pool gate has a clip style latch. LPA viewed each latch as secure.

Per licensee there are no firearms or ammunition on the premises, LPA did not observe any firearms. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. Carbon monoxide detector was tested and LPA was able to hear a successful test. LPA observed no stairs in this home. In the dinning room there is a sliding glass door to access the outdoor area and the garage with a one step down. Per Licensee, children play on the side of the home and at times play in the front yard. Outdoor play toys were observed in the front yard. LPA advised, per CCR 102417(g)- (g) The home shall be free from defects or conditions which might endanger a child.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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Document Has Been Signed on 10/27/2022 05:10 PM - It Cannot Be Edited


Created By: Deborah Lowe On 10/27/2022 at 04:26 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: ALON FAMILY CHILD CARE
FACILITY NUMBER: 197415612

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with licensee, and record review in Guardian, the licensee did not comply with the section cited above in 3 out of 4 adutls present in the home do not have a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/04/2022
Plan of Correction
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LPA provided LIVE SCAN document. Licensee will send adults to obtain criminal record clearance and will email LPA Lowe with the receipt of Live Scan. Licensee will email to LPA Lowe on or before end of business on 11/04/2022 at deborah.lowe@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


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Document Has Been Signed on 10/27/2022 05:10 PM - It Cannot Be Edited


Created By: Deborah Lowe On 10/27/2022 at 04:26 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: ALON FAMILY CHILD CARE
FACILITY NUMBER: 197415612

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with licensee, the licensee did not comply with the section cited above in white metal gate is in need of repair and is accessible to children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/04/2022
Plan of Correction
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Licensee stated they will place the front yard as off limits until gate is repaired. Licensee stated they will provide a declaration and email to LPA Lowe on or before end of business on 11/04/2022. Deborah.lowe@dss.ca.gov
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with licensee, the licensee did not comply with the section cited above in licensee is not conducting fire drills with children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/04/2022
Plan of Correction
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Licensee will create a drill log and email drill log to LPA Lowe at deborah.lowe@dss.ca.gov on or before end of business on 11/04/2022.
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:Lisa Rios
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


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Document Has Been Signed on 10/27/2022 05:10 PM - It Cannot Be Edited


Created By: Deborah Lowe On 10/27/2022 at 04:26 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: ALON FAMILY CHILD CARE
FACILITY NUMBER: 197415612

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on interview with licensee the licensee did not comply with the section cited above in licensee and A1 do not have immunization record availalble which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2022
Plan of Correction
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Per licensee, Licensee and A1 they will need to contact their doctor to obtain a record of MMR, Tdap, TB, and Flu. Licensee stated they will email LPA Lowe completed immunzation records on or before end of business on 11/11/2022. Deborah.lowe@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


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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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ALON FAMILY CHILD CARE
FACILITY NUMBER: 197415612
VISIT DATE: 10/27/2022
NARRATIVE
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Safety precautions shall include but not limited to: LPA Lowe observed the white metal gate surrounding front of property is in need of repair. Gate observed with broken area from ground to bottom of gate and parts of gate with sharp edges accessible to children.

Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 577-8709.

LPA discussed Safe Sleep Regulations with licensee.

Per Licensee, the licensee and staff 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.

Due to time restraints children and employee files were not reviewed at this visit. LPA will review files at future visit. LPA observed a current Mandated Reporter certificate completed on 8/18/2021.

LPA observed a current CPR/ First Aid with an expiration date of December 2023.

Per licensee immunization records for influenza, pertussis and measles for licensee and A1 are not on file. Licensee stated they will need to contact physician for a copy. Per H&S Code 1597.622(c) - (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.

Per licensee, primary care givers are the licensee and adult 1. Licensee arrived at 2:15 pm stated they just arrived from an appointment, LPA observed 9 children in care napping with Licensee and A1. LPA asked who was with A1 while licensee attended appointment? Per Licensee, they had an appointment and requested A2 to assist A1 with supervising the children while they napped. LPA observed 3 adults present in the home without a criminal record clearance or exemption. LPA advised, per CCR 102370 (d)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.



Incidental Medical Services (IMS) are currently being provided as needed by doctor notification. 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: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ALON FAMILY CHILD CARE
FACILITY NUMBER: 197415612
VISIT DATE: 10/27/2022
NARRATIVE
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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, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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/process.

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.

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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

LPA Deborah Lowe informed licensee Keren Alon that this report dated 10/27/2022 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Lowe informed the licensee to provide a copy of this licensing report dated 10/27/2022 that documents any Type A citation(s) 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.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ALON FAMILY CHILD CARE
FACILITY NUMBER: 197415612
VISIT DATE: 10/27/2022
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Keren Alon.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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