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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019920
Report Date: 07/18/2023
Date Signed: 07/18/2023 01:16:31 PM

Document Has Been Signed on 07/18/2023 01:16 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MASON FAMILY CHILD CAREFACILITY NUMBER:
198019920
ADMINISTRATOR:JODI MASONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 298-9984
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jodi Mason - LicenseeTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 11:10am, LPA met with licensee, Jodi Mason. The licensee states that she currently has 10 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 6am-5:30am, Monday-Friday

This is a one-story home which consists of 3 bedrooms, 3 bathroom, kitchen, dining area, living room, family room (day care room), detached garage, front yard and backyard (fenced). There is a pool on the property that meets Title 22 regulations. The children use the living room, bathroom in the hallway, Learning area, kitchen, dining area, family room (day care area), backyard. Per licensee, areas off limits to children and parents include: the bedrooms, two bathrooms and the detached garage. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 4 adults and 0 children currently live in the home. Persons living in home identified on attached LIC811. Licensee states that she currently has two assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there is a firearm on the premises that meets Title 22 regulations. Attached LIC812 describes storage.

PHYSICAL PLANT


At 11:20am, LPA was lead on a tour of the facility by the licensee. Upon entry into the home, LPA reviewed the living room. THere is a large couch available for children to sit on. There is a fireplace in the corner of the room that is made inaccessible to children in care. Per licensee, the living room will be used as an area for an ill child until an authorized representative comes to pick up child. After the living room is the learning area. There are small tables and chairs for children. LPA observed the storage of napping equipment: cots. To the left, there is a hallway that has a bathroom available for children to use. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. Bathroom was observed to be safe, clean, and free of hazards. REPORT CONTINUES PAGE 1 of 3
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2023
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920
VISIT DATE: 07/18/2023
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Back through learning area, there is a safety gate that separated the back room (day care room). There are many age appropriate toys and equipment available for children. LPA observed three play yards available. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. Smoke and carbon monoxide detectors were tested and are operable. The tour continued to the kitchen where children have access. Sharp knives are kept in a high cabinet, out of reach of children in care. There is a small dining area with age appropriate chairs and tables for children. The licensee states that a cell phone is used and stays at the facility during operating hours. There are first aid supplies available. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

At 11:40am, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There was plenty of yard space for children in care to run and play. There were bikes and play equipment for use. There is another gate that leads to the swimming pool on facility property. LPA reviewed the fencing. The pool fencing was observed to be at least 5ft and surrounding the entirety of the pool. It was a self latching gate that opens away from the pool. The latch was no more than 6inches from the top and had a padlock on it as well. The vertical rails of the fence are no more than 4inches apart and the bottom gate no more than 4 inches from the concrete ground. Per licensee, the pool is used on Fridays during the summer and there are minimum three staff supervising. Licensee states they also hire 2 lifeguards to be here on those days. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 03/2020. LPA discussed the important of having a current Pediatric CPR/First Aid training while caring for children. This deficiency needs to be corrected. Licensee and other personnel have complete mandated reporter training that expires 08/10/2024. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/ REPORT CONTINUES PAGE 2 of 3

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920
VISIT DATE: 07/18/2023
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The following was discussed: -Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There are no pets on the premises.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home

Infant Care: Licensee states that they are currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the learning room or daycare room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.


Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

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

REPROT CONTINUES PAGE 3 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920
VISIT DATE: 07/18/2023
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Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (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

The Notice of Site Visit (LIC 9213) – must remain posted for 30 daysduring the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Licensee Jodi Mason, at 1:13pm. Copy of report provided.

END OF REPORT PAGE 4 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/18/2023 01:16 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 07/18/2023 at 01:03 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on record review and interview, the licensee did not comply with the section cited above as their Pediatric CPR/First Aid certificate expired and is not current, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/01/2023
Plan of Correction
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Per licensee, they will register for a Pediatric CPR/First Aid course and submit proof of registration to LPA by POC 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:Claudia Guangorena
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2023


LIC809 (FAS) - (06/04)
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