198400630-3-14-2024-54-CC-FWHE-D3CRTA-20240314131800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400630
Report Date: 03/14/2024
Date Signed: 03/14/2024 01:18:12 PM

Document Has Been Signed on 03/14/2024 01:18 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	SHIRLEY FAMILY CHILD CARE		FACILITY NUMBER:	198400630
ADMINISTRATOR:	LILLIAN A.E. SHIRLEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 228-9048
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS:	DATE:	03/14/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Lillian Shirley, Licensee		TIME COMPLETED:	01:30 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	Licensing Program Analyst (LPA) Franchesca White conducted an Annual/Capacity Increase inspection to the above facility for the purpose ofan annual inspection and increasing capacity from a small to a large family child care home max capacity 12. Fire clearance was granted on 2/26/2024. LPA announced purpose of visit and met with, Licensee, Lillian Shirley and was taken on a guided tour of the facility both indoors and outdoors. Adults in the home were discussed and all have criminal record clearance. There was one daycare child present. Hours of operation are 23 hours / 7 days a week. Parent Board was observed to have License, Parent's Rights Diaster Plan, and Disaster Drill Log. The last drill was conducted 2/6/2024. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home that consists of three bedrooms, one bathroom, living room, dining room, kitchen, laundry area, front yard (fenced) and back yard. Off limit areas include three bedrooms, laundry area and backyard . Main care area was inspected for the health, safety, comfort, and proper ventilation for the children in care. The main care area of the home is the Living room. The living room has two couches and a mounted tv high above a non-operational fireplace. At the entrance of the home there is a pull fire alarm to the right. Smoke detector is mounted in the living room with a carbon monoxide detector amounted above the entrance to the kitchen. The living room had a cot for a sleeping child, as well as a baby trend pack n play situated near a couch. There is a book case with several reading options for the children, a wooden table and chairs for children to eat their meals, and do table activities. There is a large heater with a tall barricade that is bolted to the wall. Before entering the hallway there is a 2A 10BC Fire Extinguisher with a service tag 7/12/2023. LPA observed the bathroom to have an operable toilet and sink with handwashing supplies, toilet paper and paper towels. All cabinets had child locks making them inaccessible to children in care. LPA did not observe any chemicals in the restroom. ......................................................Report Continues 1 of 3 Pages................................................................

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SHIRLEY FAMILY CHILD CARE	FACILITY NUMBER: 198400630
	VISIT DATE: 03/14/2024

NARRATIVE

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LPA observed the kitchen to be made inaccessible to children in care with the use of a baby gate. The exit to the back yard is through the kitchen. LPA observed child safety locks to be on the cabinets in the kitchen making the contents inaccessible to children in care. LPA White discussed making adjustments to safety precautions as needed based on the age, and activity of the children in care.

LPA observed all off limit areas to be made inaccessible by locks on the doors, and a baby gate blocking access to off limit areas.

LPA White observed front play yard to have tricycles, balls, and other age appropriate toys for children. LPA observed a gate on the right side of the house blocking access to the backyard where a separate home bearing a different address from the licensee's home. Licensee states that occupants use a rear entrance to access their home, and rarely used an entrance on the left side of the house to access their home. LPA observed the front yard to be completely fenced in with a lock on the gate securing the play area for children in care.

LPA White reviewed staff and children files. Licensee has current

mandated reporter training dated 7/22/2022.
CPR Training with expiration date of 7/2025
proof of immunization against pertussis, measles, TB, and influenza

LPA discusses with Licensee that these items should always be available during inspections.

Per Licensee, there are no weapons, firearms, or bodies of water in and around the home and none were observed at time of inspection. LIcensee has one dog that is kept in a kennel that is always in a off limits area that is either locked with a door lock or barricaded with a baby gate.

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.

..................................................Report Continues 2 of 3 Pages....................................................

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SHIRLEY FAMILY CHILD CARE	FACILITY NUMBER: 198400630
	VISIT DATE: 03/14/2024

NARRATIVE

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Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.

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.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee Lillian Shirley 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. Megan’s Law - Family Child Care Homes

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today.
Based on today's observations LPA will submit to Department for final review and approval for a large family child care home.

Pending approval, Licensee must meet regulatory requirements and license limitations.

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

Exit interview was conducted and report was reviewed with the Licensee, Lillian Shirley.

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

.......................................End of Report 3 of 3 Pages...............................................................................

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

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