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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492834
Report Date: 02/08/2023
Date Signed: 02/08/2023 05:43:12 PM

Document Has Been Signed on 02/08/2023 05:43 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:BUTTLER FAMILY CHILD CAREFACILITY NUMBER:
197492834
ADMINISTRATOR:BUTTLER, LUCINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 431-0459
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Lucinda ButtlerTIME COMPLETED:
05:25 PM
NARRATIVE
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On 2/8/2023 Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced one year required visit for the Buttler Family Child Care Home. Present in the home was licensee Lucinda Buttler, licensee's two biological children and three day care children. The home is a single family, single story home with 3 bedrooms and one bathroom. Day care activities were conducted in the living room and the dining area of the home, previously operations were conducted in the den, however due to flooding, operations were temporarily relocated. The home was inspected inside and out for Health and Safety compliance per Title 22.
LPA observed the following:
Care and supervision were observed
The homes capacity was within the scope of the license
Appropriate size fire extinguisher, carbon and smoke detectors were present & operable.
Detergents, and knives were inaccessible, Toxins were locked and inaccessible.
The homes kitchen was inaccessible to children in care The home was clean and orderly.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 02/08/2023 05:43 PM - It Cannot Be Edited


Created By: Jillinda Chandler On 02/08/2023 at 03:40 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: BUTTLER FAMILY CHILD CARE
FACILITY NUMBER: 197492834

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 record review, the licensee did not comply with the section cited above per licensee fire drills were last conducted in 2022 which poses a potential safety risk to persons in care.
POC Due Date: 02/10/2023
Plan of Correction
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Licensee shall conduct a fire drill and log no later than 2/10/2023
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on ecord review, the licensee did not comply with the section cited above in 2 out of 3 children files were not available which posesa potential health and safety risk to persons in care.
POC Due Date: 02/17/2023
Plan of Correction
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licensee shall collect required documents i.e.. LIC. 613A,LIC 9224,LIC 700,LIC995,LIC627 and immunization records. Licensee was provided the LIC 125 -Entrance check list.
Licensee has until 2/17/2023 to provide proof of files
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:Claudia Escobedo
LICENSING EVALUATOR NAME:Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023


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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: BUTTLER FAMILY CHILD CARE
FACILITY NUMBER: 197492834
VISIT DATE: 02/08/2023
NARRATIVE
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The home had a properly working telephone. LPA observed the homes parent notification board; the license, facility sketch, Emergency Disaster Plan, and Notification of Parent’s Rights Poster. The following were not observed. Lead Poison Awareness, Safe Sleep and California Safety Seat Law were not posted. A first aid kit was observed containing the required supplies: scissors, tweezers, bandages, medical ointment and a thermometer. Licensee’s Pediatric CPR and First Aid Card expires 3/1/2023 No bodies of water were observed on the premises
Children records were in need of updating, licensee did not have files for 2 of 3 of the children present.
Personal records were reviewed, LPA did not observe the MMR immunization record for licensee, licensee was advised to provide immunizations for Measles no later than 2/22/2023
Licensees Mandated Reporter certificate expires 6/9/2024
A roster was readily available, in need of updating
Parents and authorized adults sign children in and out using their original signatures.
Licensee does not provide Individual Medical Services (IMS). IMS was discussed with licensee.
All adults in the home cleared a Criminal Background Clearance.
Toys, equipment and materials available and in good order Children napped on cots, cots were found to be in good condition. Infant safe sleeping was discussed with licensee.
No guns or weapons present as stated by the Licensee, no weapons observed by LPA
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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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: BUTTLER FAMILY CHILD CARE
FACILITY NUMBER: 197492834
VISIT DATE: 02/08/2023
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LPA reminded licensee that children are only to use car seats during transportation, and appropriate children’s feeding chairs shall only be used during mealtime. Outdoor activities were conducted in the back yard the yard is fully enclosed with a 4 foot or higher gate LPA did not observe any hazardous conditions in this area.

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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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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: BUTTLER FAMILY CHILD CARE
FACILITY NUMBER: 197492834
VISIT DATE: 02/08/2023
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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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Lucinda Butler

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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