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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494797
Report Date: 08/24/2023
Date Signed: 08/24/2023 05:27:21 PM

Document Has Been Signed on 08/24/2023 05:27 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:GORE FAMILY CHILD CAREFACILITY NUMBER:
197494797
ADMINISTRATOR:GORE, ASAH-YANAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 245-3517
CITY:INGLEWOODSTATE: CAZIP CODE:
90304
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Asah-Yanah GoreTIME COMPLETED:
04:20 PM
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On 8/24/2023 Program Analyst (LPA), Judy Laureano and Cristina Castellanos conducted an unannounced Annual Required Inspection at 4108 W. 107th Street, Inglewood, CA 90304. During today’s inspection was licensee and assistant C. Ogbuehi with 6 children providing care and supervision.

The hours of operation are Monday – Friday 6:00 a.m. to 6:30 p.m. LPAs toured the home inside and outside. Currently facility is available to take children ages birth to 5 years old. Facility is licensed for a Large family Child Care license with a max capacity of 14 children. Licensee is NOT available for evening, overnight care or weekend care. Currently living in the home is licensee only.

This is a duplex with a front unit and back unit. The licensee’s home consists of 3 bedrooms, 1 ½ -bathroom, kitchen, dinning room and living room area . Child care is conducted in the living room, bedroom 1 and bedroom 2. Dining room and kitchen area are only used for eating. LPAs observed a safety gate between the living room and kitchen area. The bathroom that children use was inspected and observed.

Licensee confirmed the following areas as OFF LIMITS: personal/office space located next to the full bathroom. LPAs observed the door to be closed and Licensee acknowledged that children may never enter these off-limit areas. The backyard was observed and inspected. LPAs requested licensee to submit an outdoor schedule via email.

There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds are kept in the to shelf above the kitchen sink.

Licensee confirmed that home is available to take in a child that might need medication, currently home has a child that needs medication. LPAs reminded licensee to ensure that all necessary documents are kept on file and medication is always in its original packaging.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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 08/24/2023 05:27 PM - It Cannot Be Edited


Created By: Judy Laureano On 08/24/2023 at 03:31 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: GORE FAMILY CHILD CARE
FACILITY NUMBER: 197494797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 1 current certificaiton, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/14/2023
Plan of Correction
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Licensee agrees to send completed certicication and course registration to LPA via email by due 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:Claudia Escobedo
LICENSING EVALUATOR NAME:Judy Laureano
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023


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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: GORE FAMILY CHILD CARE
FACILITY NUMBER: 197494797
VISIT DATE: 08/24/2023
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LPAs observed licensee test the carbon monoxide and smoke detector in the home. LPAs observed 2 working fire extinguisher; one in the living room and hallways. Licensee confirmed that home provides meals and snacks and is currently participating in the local food program. LPAs discussed the importance of maintaining a system where allergies and food restrictions are noted. LPAs observed an allergy list outside the refrigerator making all who assist with care supervision aware of restrictions.

Adequate heating and ventilation for safety and comfort were observed in the space. Safe toys and play equipment were observed. The home has working telephone service and LPAs confirmed the phone number 310-245-3517.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained during today’s inspection.

Safe Sleep regulations were discussed due to program being available for infant care. There is one crib or play yard for each infant in care, cribs and play yards are 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. Infants up to 12 months of age are placed on their backs for sleeping. Individual Infant Sleeping Plan was discussed and LIC form was reviewed. LPAs reviewed sleeping log for current infants in the program.

LPAs reviewed licensee’s file and observed file was complete. Mandated Reporter training was not available for review. Licensee’s CPR and First Aid Certification needs to be renewed - LPAs issued a Type B citation. LPAs reminded licensee the importance of making sure all vendors providing CPR and Pediatric CPR need to be EMSA approved.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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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: GORE FAMILY CHILD CARE
FACILITY NUMBER: 197494797
VISIT DATE: 08/24/2023
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LPAs discussed all necessary forms needed in each staff file and children’s file. LPAs provided licensee with a current copy of the LIC 311D to use as a reference when auditing files. LPAs reviewed 6 children’s files and observed files to be complete.

Family Child Care Homes Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPAs 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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee, Asah-Yanah Gore, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

Exit interview conducted and report was reviewed with Licensee, Asah-Yanah Gore.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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