198004718-6-26-2024-33-CC-MSIA-D6LP8D-20240626110521

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004718
Report Date: 06/26/2024
Date Signed: 06/26/2024 11:05:54 AM

Document Has Been Signed on 06/26/2024 11:05 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	UNDERWOOD FAMILY CHILD CARE		FACILITY NUMBER:	198004718
ADMINISTRATOR/ DIRECTOR:	UNDERWOOD, GEORGE & BRENAE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 814-8079
CITY:	BALDWIN PARK	STATE: CA	ZIP CODE:	91706
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 2	DATE:	06/26/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Licensee George Underwood and Brenae Underwood		TIME VISIT/ INSPECTION COMPLETED:	11:55 AM

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	Licensing Program Analysts (LPA) Mary Silva conducted an unannounced annual inspection at the above facility on 06/26/24. Licensing staff met with Licensee and co licensee, George Underwood and Brenae Underwood to whom the reason for the visit was explained. LPA was guided on a tour of the facility. There were two daycare children present during this inspection. Facility capacity is in compliance for a Large Family Child Care Home. Per licensee eight children are currently enrolled. Hours of operation are Monday-Friday 6:00 AM-6:30 PM. The facility is a two story home that consist of 3 bedrooms, 3 bathrooms, kitchen, dining area, living room, daycare room(den), fenced front yard, fenced backyard, and attached garage. The areas accessible to children are kitchen, dining area, living room, daycare room(den), one bedroom and one bathroom located downstairs and backyard. There is a separate entrance for parents to access the facility located to the right side of the front yard that leads to kitchen side door and the back door. LPA(s) observed a fish tank in the day care room/den. The areas inaccessible to children are 2 bedrooms(one located upstairs and one located downstairs), 2 bathrooms(located upstairs), front yard and attached garage. LPA(s) observed the stairway to the second floor is blocked with a safety gate making it inaccessible to children in care. Currently residing in the home are three adults and two minor children. LPA observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. Per licensee has not conducted a disaster drill this year, 2024. The home was observed to be clean and orderly, with central air and heating. Licensing staff observed the smoke detector and the carbon monoxide detector to be in operable condition. _________________________________Page 1_______________________________________

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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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Document Has Been Signed on 06/26/2024 11:05 AM - It Cannot Be Edited

Created By: Mary Silva On 06/26/2024 at 09:48 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: UNDERWOOD FAMILY CHILD CARE	FACILITY NUMBER: 198004718
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, fire extinguisher was not serviced yearly which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/10/2024
	Plan of Correction
1 2 3 4	Licensee's will service fire extinguisher and submit picture of service tag by POC due date.

Type B

Section Cited

CCR

102417(g)(9)(A)

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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Facility has not conducted a fire and disaster dril in 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/10/2024
	Plan of Correction
1 2 3 4	Licensee will conduct a disaster drill and submit a copy of log by POC due date.

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:

Christina Gabelman

LICENSING EVALUATOR NAME:

Mary Silva

LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: UNDERWOOD FAMILY CHILD CARE	FACILITY NUMBER: 198004718
	VISIT DATE: 06/26/2024

NARRATIVE

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Licensing staff observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with service tag dated 05/30/2023. Reminded licensee fire extinguisher should be serviced yearly. The home maintains telephone service via land line and cell phone. There are toys and other age-appropriate material available for children. Licensee prepares dinner and pm snack for the children in care. Licensee transports children before and afterschool.

Per Licensee there are no firearms or weapons stored in the home. Smoke and carbon monoxide detectors were tested and are operable on this day. Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, to be made inaccessible to children. Licensing staff reminded licensee smoking is not allowed in the home.

The Licensee uses the back yard for outdoor play. The outdoor play areas were observed to be fenced. Licensing staff observed that the outdoor yard has toys and other materials for children to play with. LPA observed a trampoline in the side of the yard. Licensee submitted a declaration with instructions for supervision. Licensee states there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit.

Child’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights.

Licensee file was reviewed for the following: LIC 508- Criminal Record Statement, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Pediatric First Aid and CPR certification expires on 01/07/2026 for George and Brenae Underwood. Mandated Reporter Training has been completed and expires on 05/25/2025 for George Underwood and on 07/15/2025 for Brenae Underwood. www.mandatedreporterca.com

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: UNDERWOOD FAMILY CHILD CARE	FACILITY NUMBER: 198004718
	VISIT DATE: 06/26/2024

NARRATIVE

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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-and-resources/safe-sleep as an additional resource. Licensee currently does not have infants enrolled. 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/.

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/process.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: UNDERWOOD FAMILY CHILD CARE	FACILITY NUMBER: 198004718
	VISIT DATE: 06/26/2024

NARRATIVE

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MyChildCarePlan.org – Centers and Family Child Care Homes - Licensee, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law - Family Child Care Homes - During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) 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. Appeal rights were provided. Exit interview conducted and report was reviewed with the Licensee, George Underwood and Brenae Underwood.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC809 (FAS) - (06/04)

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