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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493640
Report Date: 02/10/2022
Date Signed: 02/10/2022 12:33:10 PM

Document Has Been Signed on 02/10/2022 12:33 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KING FAMILY CHILD CAREFACILITY NUMBER:
197493640
ADMINISTRATOR:KING, TRACIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 309-7664
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 4DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Licensee/Licensee's AssistantTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 02/10/22 at 9:45 AM. Upon arrival, LPA disclosed the purpose of the inspection and initially met with Licensee's Assistant, who guided the LPA on a tour of the facility. Licensee, Tracie King, arrived at facility at 10:30 AM. Adults living in the home were discussed and all have criminal record clearance. There were four day care children present during today’s inspection. Licensee's Assistant states that there are currently eleven children enrolled. The children's roster was reviewed and is current. Per Licensee's Assistant, the facility’s hours of operation are Monday thru Friday 7:00am to 6:00pm. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. LPA observed disaster drill log was also available during today’s inspection, last drill conducted on 02/2022.

This is a single-story home which consists of two bedrooms and one bathroom, kitchen, and living room. Areas used by the children include the living room (located upon entry) and Bathroom 1 (located to the right of the home). Per Licensee, areas off limits to children and parents include kitchen and rear area of the home containing all bedrooms. LPA observed that there is an operable baby gate separating areas used by children and off-limits area. LPA also observed bedroom doors to be locked at time of inspection.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed ceiling fan and central and wall heater with barricade in rear off limits area of home. There is a working telephone maintained in the home. At 10:00 AM, LPA observed living room to have small tables, chairs,
Report continues- Page 1 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 197493640
VISIT DATE: 02/10/2022
NARRATIVE
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book shelf, fish tank in the corner of room, art table, wooden play kitchen and other age appropriate toys, free of loose and sharp parts. At 10:01 AM, LPA observed wooden play kitchen that children were using to be visibly dirty and sticky to touch at time of inspection. At 10:04 AM, LPA observed Bathroom 1 to have operable toilet and sink at time of inspection. At 10:05 AM, LPA observed under cabinet sink with inoperable child safety lock to contain clorox and other cleaning solutions accessible to children in care at time of inspection. Licensee states she has a pet in the home that is kept in off limits backyard at all times. LPA did not observe or hear the pet during entire time of inspection. The Licensee states that there are no medicines in the home at this time.

Per Licensee's Assistant, the children will have access to front yard area for outdoor play. LPA observed children using front yard area for outdoor play at time of inspection. LPA observed front yard adequate perimeter fencing through-out the yard. LPA observed large trampoline with netting and zipper entrance well maintained, plastic play house, and other age appropriate toys free of loose and sharp parts available for the children at time of inspection.

Per Licensee, she has weapons in her home kept in a locked gun cabinet in off limits bedroom. LPA observed gun cabinet in off limits bedroom to be closed and locked, requiring a key to open. Per Licensee, there are no bodies of water on premises and LPA did not observe any bodies of water at time of inspection. Per Licensee, they provide food for children in care.

At 10:07 AM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged but with no service tag at time of inspection. Licensee acknowledges that this fire extinguisher is over a year old and she will purchase a new one. At 10:08 AM, LPA observed smoke and carbon monoxide detectors are in operable condition at time of inspection. Per Licensee, First Aid kit is kept on Kitchen counter, LPA observed First Aid kit. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection for Licesnee. The Licensee has taken the Mandated Reporter Training but is expired.
—CPR Card valid until: 02/27/2022
—Mandated Reporter AB1207 Completed: 09/15/2019 Report continues- Page 2 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 197493640
VISIT DATE: 02/10/2022
NARRATIVE
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The following were discussed:
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.



Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.
Report Continues - Page 3 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 197493640
VISIT DATE: 02/10/2022
NARRATIVE
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LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/www.mandatedreporterca.com

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Tracie King.


Report Ends - Page 4 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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Document Has Been Signed on 02/10/2022 12:33 PM - It Cannot Be Edited


Created By: Katrina Chicote On 02/10/2022 at 11:59 AM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 197493640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, at 9:53 AM LPA observed bathroom that children will use with under cabinet sink that has inoperable child safety lock containing clorox and other cleaning solutions making these items accessible to children in care which is an immediate health, safety, and personal rights risk to children in care.
POC Due Date: 02/11/2022
Plan of Correction
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Licensee states she will replace the lock and provide photo proof to LPA by text by the POC date.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


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Document Has Been Signed on 02/10/2022 12:33 PM - It Cannot Be Edited


Created By: Katrina Chicote On 02/10/2022 at 11:59 AM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 197493640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, at 9:58 AM LPA observed wooden play kitchen that LPA observed children using in living room to have a sticky feeling and visibly dirty (photos taken). This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 03/10/2022
Plan of Correction
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Licensee states she will clean up wooden play kitchen and provide photo proof to LPA via text by POC date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA record review and interview, Licensee has expired Mandated Reporter training and Assistants did not have proof of completion available at time of inspection. This is a potential health, safety, and personal rights risk to children in care.
POC Due Date: 03/10/2022
Plan of Correction
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Licensee states they will all complete mandated reporter training and provide proof of completion to LPA by POC date via text.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


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Page: 6 of 7
Document Has Been Signed on 02/10/2022 12:33 PM - It Cannot Be Edited


Created By: Katrina Chicote On 02/10/2022 at 11:59 AM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 197493640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022

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 LPA record review and interview, Licensee's Assistant did not have immunization records available for review at time of inspection. Licensee asked Assistant about immunization records, which Assistant confirms she has not yet provided at this time. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 03/10/2022
Plan of Correction
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2
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Licensee states she will provide proof of immunization records to LPA via text by POC date.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


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