<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494047
Report Date: 07/26/2024
Date Signed: 07/26/2024 12:12:03 PM

Document Has Been Signed on 07/26/2024 12:12 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:EVANS FAMILY CHILD CAREFACILITY NUMBER:
197494047
ADMINISTRATOR/
DIRECTOR:		RENONA EVANSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 710-8242
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Renona EvansTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On July 26, 2024, Licensing Program Analysts (LPAs), Veronica Wheatley and Devon Carus conducted an Annual Inspection and was met by Licensee Renona Evans. The licensee's operating days and hours of operation are Monday through Friday, 6:00am to 6:00pm. Parents and children enter through the front door.
LPAs toured the home and a census was taken. LPAs observed 3 day care children and 1 child of the the licensee present today. Capacity as specified on the license is being maintained. Current facility sketch reviewed and confirmed that bedroom 1 and the living room are used for providing care to children. Detergents, and cleaning solutions are made inaccessible. There is a working fire extinguisher, smoke detector, carbon monoxide detector (dual). There is adequate heating and air conditioning for safety and comfort. The home has central heating and air conditioning. There are no stairs in the home. Safe toys and play equipment are observed. Bedding is kept separate and laundered by the licensee weekly. The home has working telephone service and LPAs confirmed the phone number.

LPAs discussed Safe Sleep Regulations with licensee. Cribs and play yards will be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. LPAs did not observe any infants on the premises.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. The licensee does not transport children however the children are walked to the park. Car seats are used for transportation purposes only and are not used for sleeping children.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: EVANS FAMILY CHILD CARE
FACILITY NUMBER: 197494047
VISIT DATE: 07/26/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA reviewed children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expired. Licensee’s did not observe current pediatric CPR and First Aid. A review of records indicates that all employees and/or volunteers do have immunization records on file for influenza, pertussis and measles.

LPAs inspected the backyard. LPAs were informed by the licensee that the backyard is off-limits and the children do not use the backyard. LPA observed two dogs on the premises. One dog (poodle) is a house dog and the other dog is an outdoor dog. LPA did not observe any bodies of water. LPAs observed a firearm in a shadowbox case on the wall. Licensee states the firearm has no firing pin, or bullets in the shadowbox.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. 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. LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there are 2 Type B deficiencies being cited today.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted. A copy of the report provided to the licensee.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/26/2024 12:12 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 07/26/2024 at 11:42 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: EVANS FAMILY CHILD CARE
FACILITY NUMBER: 197494047

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on LPAs observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. The licensee's mandated reporter training has expired.
POC Due Date: 08/09/2024
Plan of Correction
1
2
3
4
The licensee will complete the Mandated Reporter Training online and submit a copy of the certificate to the Department by August 9, 2024. The website is mandatedreporterca.com
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPAs observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. The licensee 's CPR and first aid certification has expired or there is no proof of completion in the file.
POC Due Date: 08/09/2024
Plan of Correction
1
2
3
4
The licensee will complete the CPR and first aid certification in person and submit a copy of the certificate to the Department by August 9, 2024.
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:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3