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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495105
Report Date: 07/14/2022
Date Signed: 07/15/2022 04:19:27 PM

Document Has Been Signed on 07/15/2022 04:19 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:TILLMAN FAMILY CHILD CAREFACILITY NUMBER:
197495105
ADMINISTRATOR:NAKEIA TILLMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 545-0485
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Nakeia TillmanTIME COMPLETED:
11:30 AM
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On 7/14/2022 Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with applicant Nakeia Tillman the purpose of a pre licensing inspection of 3624 Bell Avenue, Manhattan Beach, CA 90266. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The licensee is applying for a Large Family Child Care Home license for a max capacity of 14. Per the application, at this time, the ages the applicant wishes to provide services for are children ages 6 weeks to 6 years old , Monday through Friday 7:00 a.m. to 6:00 p.m.
Licensee was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.
Copy of rental agreement/Lease agreement is on file reflecting Nakeia Tillman has control of property. Currently living in the home is applicant Nakeia Tillman.

Fire inspection/clearance was completed on 7/5/2022 by Suzy Contreras- Manhanttan Beach Fire Inspector.

The home is a single family unit with 3 bedrooms with bathroom, living room, dining room, kitchen and ½ bathroom, enclosed patio and attached garage. Licensee confirmed the following areas as OFF LIMITS, Bedroom 2 and Bedroom 3, enclosed patio, attached garage and the space on the side of the home.

Parents will access the home through the main entrance. Entering the home through the main entrance, you are led to the living room area that has been designated for the day
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 197495105
VISIT DATE: 07/14/2022
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care. Living room was observed to have age appropriate toys, a children’s rug and a variety of manipulative, children’s cubbies and children size tables and chairs. The living room was observed to have a barricaded fireplace that is not in used. LPA observed a wooden secured fence barricading the fireplace. In the living room space LPA observed the furnace closet that is OFF LIMITS and door is locked and barricaded with children’s cubbies. Living room area was observed to have a door that give access to the backyard.

LPA observed a hallway entryway with a safety gate. A storage closet was observed and inspected to have day care materials.

Bedroom 1 was observed. Licensee agrees to have all electrical outlets covered and the excess cable will be secured to the wall or removed. Licensee stated bedroom 1 will be designated for day care use.

LPA observed a full bathroom, bedroom 2 and bedroom 3, all designated as OFF LIMITS to the children in care. Bedroom 3 has a second door that leads to the attached garage. Attached garage is designated as OFF LIMITS to the children in care.
LPA observed a door in the attached garage that leads to the enclosed Patio. Enclosed Patio has been designated as OFF LIMITS to the children in care. Licensee confirmed that all doors will remain locked during the hours of operation.

The bathroom that children will used is located outside the living room area. LPA observed a ½ bathroom. A toilet, sink and cabinet were observed in the space. Under the sink cabinet was observed to have extra day care supplies. LPA observed cabinet to have a safety latch. LPA discussed COVID-19 recommendation such as using paper towels and displaying a handwashing sign for children to view.

The kitchen was observed and designated as OFF LIMITS to the children in care. LPA observed a child’s safety gate in the entryway of the kitchen, making the area in accessible to the children in care. Cabinets, stove, dishwasher, sink and counter space were observed and inspected. Knives and sharp objects observed to be made inaccessible to the children in care. Applicant confirmed that facility will be providing meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 197495105
VISIT DATE: 07/14/2022
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LPA observed smoke detectors throughout the home and tested during this inspection. The home is equipped with a fire extinguisher.

Next to the kitchen, LPA observed the dinning room area. Licensee confirmed that children will eat in the space. LPA observed the refrigerator across the dining room table. A pantry closet was observed next to the refrigerator.

The backyard has been designated as the outdoor area. LPA observed the area to be enclosed with a gate. A climbing/swing structure was observed in the space. LPA observed the water heater closet to be secured and locked. The back yard was observed to have two wooden side gates that that will remain closed during the hours of operations. The side of the home has been designated as OFF LIMITS.

No pets, animals or bodies of waters were observed. No firearms or poisons were observed in the home.

Licensee submitted a declaration LIC 855, stating that she indeed lives in the home. LPA observed minimal personal belongings. Licensees stated she has recently moved in and has not completely unpacked.

The following areas are OFF LIMITS to the children in care:
1. Bedroom 2 and Bedroom 3 and Full Bathroom- doors will remain closed during the hours of operations.
2. Attached garage and enclosed Patio-doors will remain locked during the hours of operations.
3. Kitchen area- safety gate will remain locked during hours of operations.
The following corrections are needed:
1. Parent board with updated information- PUB 394
2. Bedroom 1- electrical outlets covered and cable wire secured to wall and/or removed from room.
The above requirements shall be submitted by July 18, 2022. Exit interview was conducted with applicant Nakeia Tillman. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 197495105
VISIT DATE: 07/14/2022
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The following was discussed with the applicant:
Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare 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 inspection.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, 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: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, family forms/records, and information to be posted.
INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME
You are required by law to post the following in your home:
• Facility Sketch (LIC 999A) or equivalent sketch
• Notification of Parents' Rights Poster (PUB 394) - This poster must be placed in an area of the home where all parents can see it.
• Facility License (LIC 203)-Your Family Child Care Home License must be posted in an area of the home where it can be easily seen.
• Notice of Site Visit (LIC 9213) must remain posted for 30 days (during the hours that children are in care) after each site visit by a licensing representative.
• Any licensing report documenting a type “A” citation must be posted for 30 days during the hours that children are in care.
• Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 197495105
VISIT DATE: 07/14/2022
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Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.


LPA also informed applicant Nakeia Tillman 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

· Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed.


· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license. · A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 197495105
VISIT DATE: 07/14/2022
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· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.

· Changes should be reported the to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from home.

· Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference.

· Fire and safety drills must be performed every six months and documented for review by the Department.

· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

· LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

· Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
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