198401042-5-17-2024-54-CC-RDEO-D5CR82-20240517124713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198401042
Report Date: 05/17/2024
Date Signed: 05/17/2024 12:47:39 PM

Document Has Been Signed on 05/17/2024 12:47 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:	MARSHALL FAMILY CHILD CARE		FACILITY NUMBER:	198401042
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	05/17/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Applicant - Amy Marshall		TIME VISIT/ INSPECTION COMPLETED:	01:15 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	Licensing Program Analyst (LPA) Randy Derraco conducted an announced pre-licensing inspection to the above mentioned address on 05/17/24 at 9:45 AM. LPA met with applicant, Amy Marshall, who guided LPA on a tour of the home. LPA observed 2 additional adults present during inspection. Individuals residing in the home have been noted and discussed. The applicant is requesting a small family childcare home license. Per applicant, operation hours will be Monday through Friday, 7:00 AM to 5:00 PM. Applicant states that they will care for children 6 weeks old to 6 years old. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home that consists of 5 bedrooms, 2 bathrooms, living Room, dining Room, kitchen, detached garage, front yard and backyard (fenced). The off limit areas include bedrooms 2 and 3, detached garage, and front yard. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. Bedroom 4 is used a the main care area. LPA observed a wooden cubby locker for storage, age appropriate toys, napping mats and a television. A wooden tension gate was observed at the entrance of the bedroom and at the exit leading towards the back yard. Bedroom 5 was observed to have a bed and bedroom furniture. Per applicant, she plans to use bedroom 5 as napping room if needed. Bedroom 1 was observed with a bed and a dresser. The bathrooms were observed to be clean with an operable sink, faucet and toilet. The living room was observed with couches, coffee table, and an entertainment center. No sharp or pointy objects were observed to be accessible in the kitchen. LPA observed a knife set stored in a cabinet above the stove. The dining room was observed with a dining table and chairs. Per applicant, food will be provided to children in care. Applicant was advised that children bringing food from home will need to have containers labeled with their name and properly stored or refrigerated. The back yard play area was observed to have perimeter fencing. LPA observed outdoor play equipment and patio furniture in the backyard. Wooden gates on the side of the home and the detached garage were observed to be mounted to the fence. (page 1 of 4)

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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 4

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: MARSHALL FAMILY CHILD CARE	FACILITY NUMBER: 198401042
	VISIT DATE: 05/17/2024

NARRATIVE

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Areas that will be used by children were inspected for safety, comfort, cleanliness. LPA observed operable telephone service via a cellphone. Applicant was advised that cell phone must remain in the home during operation hours. Per applicant, the home is equipped with central heating and air conditioning. Detergents, cleaning compounds and hazardous items that can pose a danger to children are made inaccessible in a closet on a high shelf in the hallway. The applicant was advised that any poisons must be locked, not just made inaccessible. Parent board is visible on the side of the refrigerator with required postings. Children will nap on mats in bedroom 4 or bedroom 5. Applicant does plan on enrolling infants. Per applicant there are no pets, there are no firearms or weapons stored in the home and there are no bodies of water. LPA did not observe any of the above items. LPA observed that the Applicant has a 2A10 BC fire extinguisher in the home, purchase receipt dated 04/11/24. Smoke and carbon monoxide detector were tested and are operable. The applicant has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training and Pediatric First Aid and CPR. Applicant has proof of required immunization records. There are first aid supplies available.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov

The following documents were discussed with and provided to the applicant:
-Infant Sleep Chart
-LIC 9227 - Individual Infant Sleep Plan
-PIN 20-24-CCP - Recently Approved Safe Sleep Regulations in Effect
-LIC 624 B - Unusual Incident Report
-LIC 9040 - Facility Roster
-PUB 394L - Notification of Parents Rights Poster

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Applicant is requesting a small family child care. A small family childcare license may be granted upon

(page 2 of 4)

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARSHALL FAMILY CHILD CARE	FACILITY NUMBER: 198401042
	VISIT DATE: 05/17/2024

NARRATIVE

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Licensing Program Manager (LPM) Approval. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

Prior to approval of a small license, the following corrections must be made by 05/21/24:
- 3 sided fireplace must be made inaccessible

The applicant provided proof of control of property.

The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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) or (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.

LPA discussed the safe sleep regulations with applicant 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 [applicant, licensee, or facility representative] of the importance of (page 3 of 4)

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARSHALL FAMILY CHILD CARE	FACILITY NUMBER: 198401042
	VISIT DATE: 05/17/2024

NARRATIVE

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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.

On this date, 03/05/24 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Amy Marshall

(page 4 of 4)

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

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