198012005-2-5-2025-33-CC-SLII-DDLQ8D-20250205105635

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012005
Report Date: 02/05/2025
Date Signed: 02/05/2025 10:56:44 AM

Document Has Been Signed on 02/05/2025 10:56 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	BUTLER-ELDER FAMILY CHILD CARE		FACILITY NUMBER:	198012005
ADMINISTRATOR/ DIRECTOR:	BUTLER-ELDER, SHIRLETTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 296-0133
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 4	CENSUS: 0	DATE:	02/05/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:03 AM
MET WITH:	Licensee Shirletter Butler-Elder		TIME VISIT/ INSPECTION COMPLETED:	11:30 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

At 9:00am, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced annual inspection to the above facility. A risk assessment was conducted upon entry. LPA met with Licensee Shirlette Butler-Elder, who guided analysts on a tour of the facility. Per Licensee, there are currently 4 children enrolled. There is 1 adult and 0 children present upon arrival. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Monday-Friday, 6:00am-6:00pm.

This is a two story home which consists of 2 bedrooms, 2 bathroom, living room, play room, family room, back yard, and garage (used as add' play room). Currently residing in the home is 2 adult and 0 minor children. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home.

Areas accessible to children were inspected as follows: living room, kitchen, play room, bathroom, family room, garage (play room), and back yard. Per licensee, areas off limits to children and parents, 2 bedrooms, and upstairs. LPA toured all areas on limits during this visit. Per Licensee, there are no weapons or fire arms on the property. Bodies of water was not observed.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is central heating and portable ac's. There is telephone service via a cellphone that stays at the facility during operation hours. Updated cell phone number was obtained.
pg. 1 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BUTLER-ELDER FAMILY CHILD CARE	FACILITY NUMBER: 198012005
	VISIT DATE: 02/05/2025

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

The following was observed and reviewed during this inspection:

LPA observed the following required posted documentation in the main entry way of the facility: Facility License, (LIC) 9148- Earthquake Preparedness form, and LIC 610- Facility Disaster plan, Publication (PUB) 394- Notification of Parent Rights and Licensing Form LIC 9040- Facility Roster. Last disaster drill was conducted on 01/2025. LPA reminded licensee to complete disaster drill at least once every six months.

The home is observed to be clean and orderly. There are toys available for children. LPA observed a the required 2A 10BC fire extinguisher but no purchase receipt was available for review. LPA advised that extinguishers need to be serviced yearly or purchased yearly and retain the receipt. Smoke and carbon monoxide detectors were tested and are operable. LPA observed that the fire alarm shelf life was past due and alarm did not sound loudly. LPA advised licensee to purchase a new one and send video of working alarm. Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons 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 a family child care home. The restroom that children use was observed to be safe and sanitary.

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.

pg. 2 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BUTLER-ELDER FAMILY CHILD CARE	FACILITY NUMBER: 198012005
	VISIT DATE: 02/05/2025

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

Currently, children are using the back yard for outdoor play time. 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.

The licensee is observed to be operating within the license capacity limitations. Children’s records were reviewed for completeness and logged on LIC857.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee’s Pediatric First Aid and CPR expires on 02/2026. Licensee has current Mandated Reporter AB 1207 compliant Child Care Training Certificate on file expires on 01/2027.

LPA observed that the Licensee does have proof of immunizations.

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.

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.
pg. 3 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BUTLER-ELDER FAMILY CHILD CARE	FACILITY NUMBER: 198012005
	VISIT DATE: 02/05/2025

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/process.

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.

Currently, the licensee is in compliance with California Title 22 Regulations. There are no citations being issued today.

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

Exit interview conducted, report provided and appeal rights was reviewed with Licensee Shirlette Butler-Elder.

pg. 4 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC809 (FAS) - (06/04)

Page: 4 of 4