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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005951
Report Date: 04/29/2024
Date Signed: 04/29/2024 12:45:24 PM

Document Has Been Signed on 04/29/2024 12:45 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:JOHNSON FAMILY CHILD CAREFACILITY NUMBER:
198005951
ADMINISTRATOR/
DIRECTOR:		JOHNSON, VALERIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 357-1644
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
04/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Valerie Johnson, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) Alicia Mooberry and Ashley Calderon conducted a Required Annual Inspection on this date. Upon arrival at 9:45am LPAs met with Valerie Johnson, who provided tour of facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee, the current hours of care provided are Monday – Friday 6:00am - 6:00pm. The licensee offers overnight care, LPA discussed with licensee that "Overnight Care" means care being provided to children anytime between the hours of 6 p.m. and 6 a.m. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered care. There were 0 (zero) children present. Per licensee, there are currently 6 school aged children enrolled. Also present was Faith Lamb, Assistant. All adults present have been cleared and associated. Individuals residing in the home were discussed and noted.

This is facility is a three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen with laundry area, detached garage and front and backyard.

Per licensee, the areas used by children include: Living room, bedroom (front), dining room, bathroom, kitchen and backyard.


Off limit areas: Two Bedrooms and 1 bath inside bedroom, detached garage and enclosed area behind garage. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation, and heating. Rooms that are off-limits need to be made inaccessible during operating hours. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

The children used the kitchen to walk to the backyard. LPAs observed cleaning detergents and aerosol insecticide on top of the washer. Per licensee, the cleaners are put away in locked cabinets when children are in care. ----- Page 1 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 198005951
VISIT DATE: 04/29/2024
NARRATIVE
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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 6/15/22, Licensee was reminded that fire extinguisher needs to be serviced or replaced yearly.
Licensee was advised to post the required posted documentation in a location visible to parent/guardians of children in care. Including facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed completed facility records including LIC 9040- Facility Roster and LIC 610- Facility Disaster Plan.

The home maintains telephone service via cell phone and LAN line. LPA discussed with Licensee states that poisons stored in the home must be lock, not only inaccessible to children.

Per Licensee there are no firearms or weapons stored in the home. Isolation area for sick children waiting to be picked up is in living room, supervised and away from the other children.

Per licensee, there are no infants in care. 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. 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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPAs observed a fenced off are in behind the garage that has a car. LPA's observed a barbecue grill, a gym mat used by children with bird droppings, bags of recycling materials that need to be removed. Licensee was advised that items in yard can pose a potential risk to the health and safety of children in care. The facility does not have a pool or similar bodies of water. There is a medium sized dog in the home. Per licensee, the dog is kept in off limits bedroom during daycare hours.

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/ ---Page 2 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 198005951
VISIT DATE: 04/29/2024
NARRATIVE
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Complete Children’s records were discussed with the licensee. Licensee records were reviewed, Licensee has approved Pediatric First Aid and CPR certification (Exp. 06/15/24), Current Mandated Reporter Training Certificate. One out 2 staff does not have Mandated reporter certificate.

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.

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

Based on the LPA's observations and records review three (3) B deficiencies are cited today in accordance with California Title 22 Regulations.

Licensee was informed of the MyChildCarePlan.org website.

During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders (RSO) living in the facility and LPA completed the RSO search in Megan’s Law Website.

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

Exit interview conducted and report was reviewed with the licensee Valerie Johnson. Appeal Right Were discussed and a copy provided.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/29/2024 12:45 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 04/29/2024 at 12:03 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 198005951

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to outdoor space has hazards including barbecue grill, multiple bags of recycling material, bird droppings on mat used by children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2024
Plan of Correction
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Per licensee, the hazards in the outdoor play area will be removed and a photo of correction will be sent to LPA by POC due date.
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
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Based on observation, the licensee did not comply with the section cited above in that the 2A10BC fire extinguisher has not been serviced since 6/15/22 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2024
Plan of Correction
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Per licensee, the fire extinguisher will be serviced and a copy of the service tag will be sent to LPA via email 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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 04/29/2024 12:45 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 04/29/2024 at 12:03 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHNSON FAMILY CHILD CARE
FACILITY NUMBER: 198005951

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2024

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
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Based on interview and record review, the licensee did not comply with the section cited above in that 1 out of 2 care providers has not completed the AB102 Mandated Reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2024
Plan of Correction
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Per licenee, proof of completiong of mandated reporter will be sent to LPA by POC 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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2024


LIC809 (FAS) - (06/04)
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