198020935-9-14-2023-33-CC-RLOZ-CVP27J-20230914170849

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020935
Report Date: 09/14/2023
Date Signed: 09/14/2023 05:08:55 PM

Document Has Been Signed on 09/14/2023 05:08 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	CARLSON FAMILY CHILD CARE		FACILITY NUMBER:	198020935
ADMINISTRATOR:	CARLSON, NUBIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 715-5565
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 7	DATE:	09/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Licensee, Nubia Carlson		TIME COMPLETED:	05:15 PM

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 3:30 pm Licensing Program Analysts (LPAs) Roxana Lopez and Shushanik Safaryan conducted an unannounced required 1 year inspection to the above facility. A COVID risk assessment was conducted upon entry. LPA met with Nubia Carlson, Licensee who guided analysts on a tour of the facility. Per Licensee, there are 8 children that are currently enrolled. A current children’s roster was available for review. There were 7 children present upon arrival- also present was 1 assistant. The licensee states that 2 adults and 2 children currently live in the home. Per Licensee, they currently have 1 assistant. 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. Licensee states that there are weapons store in the home. LPA observed all weapons to be in an off limits area. This is a one story home which consists of 2 bedrooms, 2 bathrooms, living room, family room/playroom dining room, kitchen, laundry room, garage and backyard (fenced). The children have access to family room/playroom, living room, dining room, kitchen, 2 restrooms and backyard fenced. Per licensee, areas off limits to children and parents include, 2 bedrooms and garage. The LPA toured all areas used by children during this visit. LPA observed off limits area to be inaccessible to children in care. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone that stays at the facility during operation hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection. ----------------- pg.1 of 4---------------------------------------

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARLSON FAMILY CHILD CARE	FACILITY NUMBER: 198020935
	VISIT DATE: 09/14/2023

NARRATIVE

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Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Poisons are locked in the off limits garage. The restroom that children use was observed to be safe and sanitary.

LPA Lopez did observed a fireplace in the family room which was barricaded and inaccessible for children in care. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 4/26/2023, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 9/1/2023.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the entrance of the home.

The home is observed to be clean and orderly. There are toys available for children. Nap is not offered at this time as schedule is 1:30-5:00pm

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.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARLSON FAMILY CHILD CARE	FACILITY NUMBER: 198020935
	VISIT DATE: 09/14/2023

NARRATIVE

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Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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. LPA did not observe any objects that can pose a danger to children on the outdoor yard.

The licensee is observed to be operating within the license capacity limitations.

At 3:30 pm children’s records were reviewed, including emergency information and all records were complete.

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 4/2025. There are first aid supplies available.LPA observed that the Licensee and assistant do have proof of immunization record and have current Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.
This fIMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

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.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARLSON FAMILY CHILD CARE	FACILITY NUMBER: 198020935
	VISIT DATE: 09/14/2023

NARRATIVE

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

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.

During the exit interview, the LICENSEE Nubia Carlson, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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

Exit interview conducted and report was reviewed with Licensee Nubia Carlson

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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