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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493640
Report Date: 04/12/2023
Date Signed: 04/12/2023 05:52:58 PM

Document Has Been Signed on 04/12/2023 05:52 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
MONTEREY PARK S WEST, 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: 14CENSUS: 8DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tracie King, LicenseeTIME COMPLETED:
06:15 PM
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Licensing Program Analysts (LPAs) Franchesca White and Katrina Chicote arrived at the above listed facility at 1:30 p.m. for the purpose of an 1 year annual inspection. We were greeted by Licensee Tracie King, and upon entry of the home, LPA White provided Licensee King with the entrance checklist and explained the purpose of the visit. Licensee gave LPAS tour of the facility and gave us her staff files for review. Licensee and Staff 1 (S1 are cleared and associated to the facility. There were 6 enrolled children and 3 of the Licensee's grandchildren making a total of 9 children in care at time of inspection. One un-associated adult (A1) present at time of inspection.

Facility is a single family home with a fenced-in outdoor play area in the front of the property. Home has a living room, kitchen, two bedrooms, two bathrooms, and cloth-partitioned area off limits to children in care. The living room is the main care area for the children. The Parent board had the facility license, personal rights, parent's rights posted on the living room wall close to the window facing the outdoor play area. The living room has three age appropriate tables, chairs, toys, blocks, books, and educational materials arranged on the main floor. ABC posters are on the walls. There are two couches and a large flat screen t.v. The smoke detector is located on the ceiling in the living room near the bathroom. The carbon monoxide detector is located in the hallway. Both were tested and operable at time of inspection.

At 1:35 p.m., LPAS observed Bathroom 1 to have one working toliet, three training potty toilets and 1 sink with soap, and paper towels . LPA observed cockroaches (photos taken) in the top drawer of the sink. There were disinfectants on the counter next to the sink, and on the toilet top which is accessible to children. LPAs observed the children using the restroom and closing the door during inspection. Floors were wet with dark foot print stains throughout the bathroom. Bedrooms 1,2 and Bathroom 2 are inaccessible to children in care with the use of an operable gate.
1 of 3 Page Report
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 197493640
VISIT DATE: 04/12/2023
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At 1:45. LPAS observed the fire extinguisher green with proof of recent purchase in 2023. The kitchen shelves were filled to capacity with food and cleaning solutions stored next to each other on one of the shelves (pictures taken). Kitchen area blocked by operable gate at time of inspection.

At 2:00 p.m., Staff records were reviewed. The Licensee did not have current Pediatric First Aid and CPR on file at time of inspection. Proof of immunization records for Licensee King available during today's inspection. Mandated Reporter Training was reviewed and taken 3/2022 for Licensee. There was no file available for Staff 1 (S1) at time of inspection.

At 2:30 p.m. LPAs reviewed Children's records and found them to be unorganized (documentation and files not matching, as well as missing required documentation such as:
    • Immunization Records
Based on observation and interview with Licensee, Adult 1 was present during inspection in the cloth - partitioned area of the home. LPA's did not observe A1 on background clearance sheet. Licensee confirm that A1 visits home, and is not cleared to be in home.

Per Licensee, there are firearms present in the home in a locked compartment in Bedroom 1. LPAS observed locked gun cabinet in off limits bedroom. When asked to open the gun cabinet, per Licensee her husband has the key and has no ammunition present in the home at time of inspection.

LPAs did not observe any bodies of water around the premises at the time of inspection.

Based on this information, the following deficiencies on the attached LIC 809 are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children's health and safety. 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.

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


2 of 3 Pages of Report
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 197493640
VISIT DATE: 04/12/2023
NARRATIVE
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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.LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

Exit interview was conducted and report was reviewed with the Licensee, Tracie King.


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End of Report

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 04/12/2023 05:52 PM - It Cannot Be Edited


Created By: Franchesca White On 04/12/2023 at 05:09 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
, 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: 04/12/2023

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 observation the Licensee did not store cleaning solutions in an area inaccessible to children in care. The Licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/13/2023
Plan of Correction
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Licensee took cleaning solutions and stored them inaccesible to children in off limits bedroom at time of inspection.
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 LPa observation and interview Adult 1 (A1) was present at the facility who was not observed on the personnel clearance. Licensee confirms she is not cleared, but visiting the facility. Licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/13/2023
Plan of Correction
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Licensee states daughter is in the vehicle. LPAS observed daughter go to the car and wait in the vehicle parked outside the facility.
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:Valarie Cook
LICENSING EVALUATOR NAME:Franchesca White
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 04/12/2023 05:52 PM - It Cannot Be Edited


Created By: Franchesca White On 04/12/2023 at 05:09 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
, 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: 04/12/2023

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 observation Licensee did not meet above criteria with the play yard gates with observable thick layer of dirt. A large filled bag of trash in the outdoor play area next to toys. Bathroom floors wet with dark foot print stains. Cockroaches crawling on the sink bowl, and in the top drawer. Kitchen piled with food and cleaning solutions next to each other on the same shelf., the licensee did not comply with the section cited above in the overall facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2023
Plan of Correction
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Licensee will have grandson help clean outdoor yard. The Licensee will provide proof of extermination to LPA with a picture of receipt sent by email or text.
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:Valarie Cook
LICENSING EVALUATOR NAME:Franchesca White
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023


LIC809 (FAS) - (06/04)
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