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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019687
Report Date: 11/01/2022
Date Signed: 11/01/2022 03:27:54 PM

Document Has Been Signed on 11/01/2022 03:27 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:ANDREWS FAMILY CHILD CAREFACILITY NUMBER:
198019687
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Marisol Andrews, LicenseeTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analysts (LPA) Susann Sanchez conducted an unannounced annual required inspection at the above facility on 11//2022 at 12:05 PM, LPA is conducting a change in capacity during inspection. LPA met with Marisol Andrews, Licensee who guided analysts on a tour of the facility. There were 4 children, 4 infants, and the Licensee present when LPA arrived. A fire clearance was granted on 10/28/22 by Fire Inspector E. Martinez.

At 1:40, during file review LPA observed that 4 infants where present during inspection. Facility capacity is not in compliance. Type A will be cited

This is two story home which consists of four bedrooms, two full bathrooms, one half bath, living room, kitchen, dining area, front yard, garage/ activity room, and backyard. The Licensee uses the living room, dining area, and garage/activity room, one bathroom, front yard. Per Licensee, areas off limits to children and parents include: all of upstairs (gated), two bathrooms and backyard. All areas were inspected during today's visit including "off limit" areas.

Hours of operation are Mon-Fri 6:00 AM - 5:00PM. Food is provided by Licensee.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 11/01/2022.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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Document Has Been Signed on 11/01/2022 03:27 PM - It Cannot Be Edited


Created By: Susann Sanchez On 11/01/2022 at 02:13 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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based onobservation and interview with licensee, the licensee did not comply with the section cited above. LPA observed a infant sleeping half in the sofa. The infants upper body was on the sofa and the rest of the body was standing. LPA observe a third infant sleeping in the high chair. Licensee stated that another infant usually sleeps in the bouncer which poses an immediate health, safety and personal rights risk to persons in care.
POC Due Date: 11/02/2022
Plan of Correction
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Per Licensee, will start using a play yard and the other infants will sleep in cots by 11/02/22 Licensee will review the safe sleep regulations and write a summary and submit to LPA by 11/10/22.
Type A
Section Cited
CCR
102416.5(b)(1)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (1) Four infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. There were 4 infants upon arrival and 4 children which poses an immediate safety and personal rights risk to persons in care.
POC Due Date: 11/02/2022
Plan of Correction
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Per Licensee, will make arrangments with parents so Licensee is not over ratio until Licensee is grant a license for a large.
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:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/01/2022 03:27 PM - It Cannot Be Edited


Created By: Susann Sanchez On 11/01/2022 at 02:13 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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. Per Licensee each child has their own sleeping cots and a play yard, however they children fell asleep before taking out the cots. Per Licensee, she will start using a play yard for the younger infant instead of the bouncer which poses a potential health, safety and personal rights risk to persons in care.
POC Due Date: 11/15/2022
Plan of Correction
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Per Licensee, once children are falling asleep, she will put children in their cots. Licensee also stated she will develop a plan with legal guardian of infant #4 to arrange child to sleep in a play yard.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. Licensee stated she has not been documenting the 15 minutes sleep check which poses a potential health, safety and personal rights risk to persons in care.
POC Due Date: 11/15/2022
Plan of Correction
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Per Licensee will start documenting children sleeping and summit a copy to LPA by due date of 11/15/22 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:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022


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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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687
VISIT DATE: 11/01/2022
NARRATIVE
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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher was last serviced on 02/04/2022. The home maintains telephone service via landline and cell phone.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. There is a gated at the bottom of the stairs. LPA observed that detergents, cleaning compounds and medication are stored in laundry area, inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home at the time.

The bathroom that children use is located near the dining area and was observed to be clean and free of hazards.

Upon arrival, around 12:10, LPA observed an infant awake in the car seat, LPA asked where the infant usually sleeps and Licensee stated in the bouncer. LPA observed another infant sleeping half in the sofa. The infants upper body was on the sofa and the rest of the body was standing. LPA observe a third infant sleeping in the high chair.

Currently licensee cares for four infants. Per Licensee, infants will sleep on cots. Licensee states she does have a play yard. LPA reminded and reviewed the Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. Consult regarding safe sleep was given from 12:10pm to 3:00pm off and on.

Currently, children are using the front yard for outdoor play. LPA's observed that the outdoor yard has toys and other materials for children to play with. LPA's did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.



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

During file review at 1:40pm, LPA did not observe LIC 9227 or the 15 minute sleep check documentation.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
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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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687
VISIT DATE: 11/01/2022
NARRATIVE
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During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

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/process.

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.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
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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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687
VISIT DATE: 11/01/2022
NARRATIVE
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Based on the LPA’s 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 & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

Once POC's are cleared LPA will submit application for a capacity increase to the department.

Exit interview was conducted with Licensee Marisol Andrews. A copy of the appeal rights were provided and explained. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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