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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494774
Report Date: 03/16/2023
Date Signed: 03/16/2023 11:36:18 AM

Document Has Been Signed on 03/16/2023 11:36 AM - 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:ALLEN FAMILY CHILD CAREFACILITY NUMBER:
197494774
ADMINISTRATOR:BEVERLY S ALLENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 505-5086
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Beverly AllenTIME COMPLETED:
11:50 AM
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On 03/16/2023, Licensing Program Analyst (LPA) Adrian Risher conducted an Annual Inspection. LPA provided Licensee with the purpose of the visit and was granted access to the facility. LPA met with Beverly Allen, Licensee. LPA toured the inside and outside of the property with the Licensee. LPA observed the home to be clean, safe, orderly and well ventilated. There were 7 children present with 2 staff. The operating hours are Monday thru Friday 7:00am to 6:00pm.

LPA observed the home to have a Living Room, Dining Room, Kitchen, 6 bedrooms, and 3 bathrooms. The Licensee utilizes Bedroom 1, living room and dining room areas as the day-care. The rest of the home is inaccessible to the children. Bedroom 1 is used as a infant napping room as needed or for storage. The living room is used for napping. The dining room is used for daily activities and eating. LPA observed mats being used for napping. LPA observed age appropriate toys and equipment for the children.

The kitchen and bathroom areas were inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects. These items were made inaccessible to children. Kitchen/bathroom drawers were made inaccessible to children in care.

Licensee states that there are no weapons in the home. Licensee has cats that stay outside. LPA observed operable smoke detectors and carbon monoxide detectors throughout the home. The home is equipped with 1 (2-A:10-B:C) Fire Extinguisher and First Aid kit which includes thermometer and band aids. The home has central heat and air. LPA observed a properly screened fire place.

LPA inspected the outside area and observed age appropriate toys. There are no bodies of water at the home. LPA observed the outside play area fenced all around.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/16/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ALLEN FAMILY CHILD CARE
FACILITY NUMBER: 197494774
VISIT DATE: 03/16/2023
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LPA completed a record review during inspection. Staff files were found to be complete. Mandated reporter and immunizations were in the files. The children's files were incomplete. LPA reviewed records related to earthquake drills and fire drills which were found to be current. All required Child Care Postings was observed on the Parent Board during inspection.

Items to be provided to LPA: 1. Completed Children's Files

The facility was issued 2 deficiencies today under section codes 102421(a) and 102421(b) Child's Records. Licensee did not have completed children's files. Please refer to 809d for deficiencies.

Licensee 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, 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.

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.

LPA reviewed with licensee 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

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the Licensee Beverly Allen.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
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Document Has Been Signed on 03/16/2023 11:36 AM - It Cannot Be Edited


Created By: Adrian Risher On 03/16/2023 at 10:52 AM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ALLEN FAMILY CHILD CARE
FACILITY NUMBER: 197494774

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee did not have completed children's files during today's inspection.
POC Due Date: 03/24/2023
Plan of Correction
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Licensee was provided with a copy of the LIC 311D FORMS/RECORDS TO KEEP IN YOUR FAMILY CHILD CARE HOME.

Licensee will notify LPA when the children's files are completed no later than 03/24/2023.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee did not have completed children's files during today's inspection.
POC Due Date: 03/24/2023
Plan of Correction
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Licensee was provided with a copy of the LIC 311D FORMS/RECORDS TO KEEP IN YOUR FAMILY CHILD CARE HOME.

Licensee will notify LPA when the children's files are completed no later than 03/24/2023.
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:Maureen Neal
LICENSING EVALUATOR NAME:Adrian Risher
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023


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