198011217-1-31-2023-54-CC-AMOY-CNM2R9-20230131163709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198011217
Report Date: 01/31/2023
Date Signed: 01/31/2023 04:37:23 PM

Document Has Been Signed on 01/31/2023 04:37 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:	SIMPSON-GIPSON FAMILY CHILD CARE		FACILITY NUMBER:	198011217
ADMINISTRATOR:	SIMPSON-GIPSON, DEBRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 329-3270
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	01/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Debra Simpson Gipson, Licensee		TIME COMPLETED:	05:00 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. Upon arrival LPA met with Zakeya Edison, Assistant, who provide a tour of the facility. LPA observed three (3) children present upon arrival. LPA informed assistant of purpose of inspection. Debra Simpson Gipson, Licensee, arrived at the home at 2:15pm. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. Also present was Phillip Gipson, Licensee's spouse. All adults present in the home have criminal record clearance. Individuals residing in the home were discussed and noted.

LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access, as well as off limit areas. Per licensee the hours of operation are Monday-Friday 6:00am-6:00pm.

This is a one story home consisting of three (3) bedrooms and (1) bathroom, living room, kitchen, family room at the rear of the home. There is a small unit connected to the detached garage, licensee states it is used as a romper room and no children are allowed inside.

Off limit areas include: The 3 bedrooms, kitchen, detached garage, back house w/ bathroom and back yard.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children.

LPA observed the facility license posted in the living room, visible to parent/guardians of children in care. Including Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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: SIMPSON-GIPSON FAMILY CHILD CARE	FACILITY NUMBER: 198011217
	VISIT DATE: 01/31/2023

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Fire extinguisher size 2A10BC was observed with service tag dated 9/2022. Licensee was reminded that fire extinguisher needs to be serviced yearly. The smoke detector and carbon monoxide detectors were tested and found operable. LPA observed wall and floor heaters to be screened in the living room and hallway. Sharp objects, toxins and hazardous materials are inaccessible to children in the kitchen and bathroom. LPA observed napping equipment and bedding in children's individual cubbies. First aid kit observed.
The licensee provides food for children in care and understands any foods brought from home need to be labeled and refrigerated if needed.
The home maintains telephone service via land line and cell phone. The bathroom that children use is located in the hallway, Licensee was reminded to ensure the child lock on under sink cabinet is checked regularly to ensure cleaning items are inaccessible to children in care.

Licensee states that there are no poisons stored in the home and understands that all poisons 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, away from the other children.

Licensee states there are currently 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.

The back yard is used for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with including a plastic structure in good repair. LPA did not observe any objects that could be hazardous to children in care.

Facility does not have a pool or similar bodies of water.

Children’s records were reviewed according to the LIC 126 and found to be complete.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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: SIMPSON-GIPSON FAMILY CHILD CARE	FACILITY NUMBER: 198011217
	VISIT DATE: 01/31/2023

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Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, 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 and current Mandated Reporter Training Certificate.

LPA discussed following the most current COVID-19 recommendations, precautions and procedures.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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 the following deficiencies will be cited today in accordance with California Title 22 Regulations.

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

Exit interview conducted and report was reviewed with the Licensee, Debra Simpson Gipson

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/31/2023 04:37 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 01/31/2023 at 03:48 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: SIMPSON-GIPSON FAMILY CHILD CARE	FACILITY NUMBER: 198011217
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2023

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 record review the licensee did not comply with the section cited above in 1 out of 2 staff files reviewed was missing the current Mandated Reporter training certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/17/2023
	Plan of Correction
1 2 3 4	Per Licensee, Staff will complete the Mandated Reporter (AB1207) training and proof of correction will be sent to LPA via email by POC due date

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 2 staff records reviewed was missing the Pediatric CPR/1st Aid certificate, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/17/2023
	Plan of Correction
1 2 3 4	Per licensee, Staff will complete the required Pediatric CPR/1st Aid and proof of correction will be sent to LPA via email.

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: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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