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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494854
Report Date: 02/13/2024
Date Signed: 02/14/2024 08:33:01 AM

Document Has Been Signed on 02/14/2024 08:33 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ZHOU FAMILY CHILD CAREFACILITY NUMBER:
197494854
ADMINISTRATOR:ZHOU, XIN YANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 706-8300
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/13/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Xin Zhou (Licensee)TIME COMPLETED:
06:40 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 02/13/2024 Licensing Program Analyst (LPA) Cristina Castellanos conducted an unannounced Annual Required Inspection at the above-mentioned facility. LPA was greeted by Licensee Xin Yan Zhou. LPA disclosed the purpose of the inspection and was granted entry into the home by the Licensee. LPA toured the home both inside and outside. Present during today’s inspection was Licensee Xin Yan Zhou and eleven (11) children in care.

Capacity as specified on the license is not being maintained during today’s inspection. Capacity Regulations for Family Child Care Home License flyer was provided to Licensee. At approximately 5:37 p.m. the last child out of capacity regulations was picked up. At the end of the visit Licensee was in compliance with capacity requirements for a Small Family Child Care Home with only eight (8) children in care.

The purpose of this inspection is to ensure that health, safety, and personal rights as required by Title 22 Regulations governing California Child Care Homes will be met by the licensee. The facility is licensed for a Large Family Child Care with a max capacity of 14 children. Currently the facility is available to take children ages newborn to five year olds. The facility hours of operation are 8:00am to 6:00pm Monday through Friday. Licensee is not available for evening, overnight or weekend care. Per licensee the individuals currently residing in the home are the licensee and licensee’s teen child.

The home is a single-family home, consisting of 3 bedrooms, 2 bathrooms, a living room, a kitchen/laundry room, a family room and a detached garage. Families enter the home through the main entrance, pass the living room and kitchen area and go directly to the family room. Licensee confirmed childcare is primarily conducted in the family room. LPA observed a fireplace in the family room barricaded by cubby storage furniture. Per licensee the family room is used for napping and eating.

Continue
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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 9
Document Has Been Signed on 02/14/2024 08:33 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 02/13/2024 at 02:49 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: ZHOU FAMILY CHILD CARE
FACILITY NUMBER: 197494854

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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 interview and record review, the licensee did not comply with the section cited above in not having a valid Pediatric First Aid/CPR certification, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2024
Plan of Correction
1
2
3
4
Licensee will provide proof of registration and/or completion of training via email to LPA by due date.
Type A
Section Cited
CCR
102416.5(d)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and Guardian record review, the licensee did not comply with the section cited above in having a total of 11 children in care with no assistant in the home, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2024
Plan of Correction
1
2
3
4
Licensee agrees that if she does not have an assistant present in the home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. The total licensed capacity for a Small Family Child Care Home shall not exceed eight children. Additionally, Licensee will submit a written statement which states that Licensee has read and understands Regulation 102416.5(a)(b) to LPA by 02/16/2024.
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:Claudia Escobedo
LICENSING EVALUATOR NAME:Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
Page: 2 of 9
Document Has Been Signed on 02/14/2024 08:33 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 02/13/2024 at 02:49 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: ZHOU FAMILY CHILD CARE
FACILITY NUMBER: 197494854

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024

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 interview and record review, the licensee did not comply with the section cited above in not having a valid Mandated Reporter Training Certification, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2024
Plan of Correction
1
2
3
4
Licensee agrees to provide proof of completion of training via email to LPA by due date.
https://www.mandatedreporterca.com/
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
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:Claudia Escobedo
LICENSING EVALUATOR NAME:Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
Page: 3 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZHOU FAMILY CHILD CARE
FACILITY NUMBER: 197494854
VISIT DATE: 02/13/2024
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
Licensee confirmed the following areas as OFF LIMITS: all bedrooms, the kitchen/laundry room and the detached garage. LPA observed child proof gates in the kitchen’s main entrance as well as in the hallway making the kitchen and all bedrooms inaccessible to all the children in care. LPA reminded licensees that any area designated as OFF LIMITS should be made inaccessible during the hours of operation and/or while children are present.

There are no firearms or ammunition on the premises. No bodies of water were observed on the premises. Detergents and cleaning compounds are kept primarily underneath the kitchen sink cabinet and the top shelf medicine cabinet in the bathroom.

Licensee confirmed the home is available to take in a child that might need medication. Currently there are no children that require medication.

Licensee confirmed the home does provide meals and snacks. Licensee confirmed the home does participate in a Child Care Food Program, CACFP. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted.

LPA observed licensee test the dual carbon monoxide and smoke detectors in the home. LPA observed a working fire extinguisher in the kitchen, near the rear exit door. LPA reminded licensee to maintain proof of an annual service for the fire extinguisher.

Adequate heating and ventilation for safety and comfort were observed in the space. Safe toys and play equipment were observed. The home has a working telephone service and LPA confirmed the phone number (562)706-8300.

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. Prohibited items in Family Child Care Home flyer was provided.

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.


Page 2
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC809 (FAS) - (06/04)
Page: 7 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZHOU FAMILY CHILD CARE
FACILITY NUMBER: 197494854
VISIT DATE: 02/13/2024
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
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 LIC9227 form was reviewed.

Licensee completed the Mandated Reporter Training on 05/29/2021 and the Pediatric CPR/Pediatric First Aid on 03/14/2021. LPA reminded Licensee the importance of completing the renewal training for both the Mandated Reporter and the Pediatric CPR/ First Aid every two years following the date of which she completed the initial training. Additionally, LPA reminded licensee the importance of making sure all vendors providing Pediatric CPR and Pediatric First Aid need to be EMSA approved. LPA reviewed 6 children’s files and observed files to be complete. LPA reminded Licensee to maintain updated immunization records on file. LPA provided licensees with a current copy of the LIC 311D and LIC126 to use as a reference when auditing files.

Family Child Care Home 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.

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-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 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.


Page 3
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ZHOU FAMILY CHILD CARE
FACILITY NUMBER: 197494854
VISIT DATE: 02/13/2024
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
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, there were three (3) deficiencies cited at this time for violation of Title 22 regulation; (see LIC809-D).

An exit interview was conducted and Plans of Correction were reviewed and developed with Licensee Xin Yan Zhou. A copy of this report and appeal rights were discussed and left with Licensee Zhou. 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.


Page 4
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC809 (FAS) - (06/04)
Page: 9 of 9