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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401153
Report Date: 05/13/2022
Date Signed: 05/13/2022 03:15:54 PM

Document Has Been Signed on 05/13/2022 03:15 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DAVIDSON FAMILY DAY CAREFACILITY NUMBER:
197401153
ADMINISTRATOR:JOAN DAVIDSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 643-6126
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: DATE:
05/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Joan DavidsonTIME COMPLETED:
03:45 PM
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On 05/13 /22 Licensing Program Analyst (LPA), Doris Whitmore conducted an unannounced Annual Required Inspection and was met by Licensee, Joan Davidson Days and hours of Operation are Monday- Friday 6:00a.m. to 6:00p.m.

LPA toured the home inside and outside and a census was taken. Current Facility Sketch was reviewed. The home is a two story, four bedroom, three bathroom home with a family room, living room, kitchen and attached garage. Per Licensee, no child care is conducted in the attached garage. The off-limit areas of the home is the second level of the home. There is a bedroom, bathroom and closet located on the second level of the home. The second floor of the home is off-limits to the children in care and made inaccessible by closed door at the stairway entrance. The bathroom located at the front of the home is also off-limits to children in care. The primary child care area of the home is in the bedroom located to the rear of the home adjacent to the family room. The bedroom at the rear of the home has been converted into a playroom. LPA observed toys, a small indoor slide and a safety gate at the doorway of the playroom. The children utilize the bathroom that is in the playroom. The infant children utilize the family room as the primary child care area. LPA observed playyards and activity gymnasium in the family room. The kitchen is utilized as an eating area. LPA observed a small children table and chair set at the kitchen entrance and high chair at the standard table area. There are also safety gates at each entryway of the kitchen to the living room. The bedrooms to the front of the home are used as napping areas. LPA observed a crib in the bedroom adjacent to the living room and a playyard in the bedroom adjacent to the bathroom at the front of the home. LPA observed screened wall heaters in the family room and the hallway adjacent to the kitchen entrance.LPA toured the home inside and outside and a census was taken. .

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVIDSON FAMILY DAY CARE
FACILITY NUMBER: 197401153
VISIT DATE: 05/13/2022
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There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Firearms and ammunition are stored and locked separately. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke/carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are stairs in this home that are off limits to the children in care. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (310) 643-6126.LPA discussed Safe Sleep Regulations with licensee. LPA shared with the Licensee that physically checks on sleeping infants will be every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are always supervised and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed all required documents were placed in file except one file. The Licensee’s Mandated Reporter Training was completed on 8/14/2018. Information was shared with Licensee that the certificate expired and will need to be taken soon as possible. Licensee was unaware certificate expired and that it would be renewed every two years. Licensee’s pediatric CPR/First Aid expired on 01/02/22. LPA share that children are in her care and will need to be renewed soon as possible. Review of records indicates that all employees and/or volunteers on file does not have documentation for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are currently not being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm. Page 2

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DAVIDSON FAMILY DAY CARE
FACILITY NUMBER: 197401153
VISIT DATE: 05/13/2022
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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited Consultation was provided to the Licensee on all of the forms.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days. Page 3

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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