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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009469
Report Date: 10/21/2022
Date Signed: 10/21/2022 01:39:47 PM

Document Has Been Signed on 10/21/2022 01:39 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KING FAMILY CHILD CAREFACILITY NUMBER:
198009469
ADMINISTRATOR:KING, INGRIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 921-5489
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 5DATE:
10/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Licensee Ingrid King TIME COMPLETED:
12:00 PM
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On 10/21/22 Licensing Program Analysts (LPAs) Jeanette Estrada and Austin Estrada conducted an unannounced required 1 year inspection at the above facility. LPAs met with the Licensee Ingrid King and informed her of the purpose for the visit. LPAs provided Licensee with a copy of the Facility Entrance Checklist. There were 5 daycare children and 1 staff present. All residents were noted and verified. Facility provides care to children ages 0 to 13 years old. Facility is open Monday to Friday 6AM to 6 PM.
This is a one story, 3 bedroom, 2 bathroom home, with a living room, dining/ tv area, kitchen/laundry room, detached garage and enclosed backyard.
Per Licensee areas on limits to children are: Living room, tv/dining room, hallway bathroom, enclosed backyard.
Per Licensee areas off limits to children are: 3 bedrooms, 1 bathroom, Kitchen/laundry area and detached garage.
All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation- Facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed and reviewed a current roster LIC 9040 and a current disaster drill log. Last disaster drill was performed in 10/20/22. There is an operable carbon monoxide/ smoke detector in the living room. LPA observed a 2A10BC Fire Extinguisher in the facility which indicated full and per Licensee was purchased in 2021. The home maintains telephone service (Land line and cell phone). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.
There are toys and other age appropriate materials available for children to use in the facility and in the backyard. Sharp objects, detergents and cleaning compounds were inaccessible to children in care. Knives are kept in an upper kitchen cabinet, Cleaning products are in a latched cabinet under the sink and in an upper cabinet in the laundry room, detergent is in the laundry room. Personal medication is stored in an off limits bedroom. Per Licensee, no children enrolled require medication.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 198009469
VISIT DATE: 10/21/2022
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There were no fireplaces observed. The home has central air and heating. Children nap in the dining/TV room and they are provided appropriate napping equipment. Children use the restroom in the hallway.
Children use the backyard for outdoor play. LPA observed the backyard fully enclosed. Per Licensee, children are supervised while playing outside. Per Licensee, there are no poisons in the home. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the living room, separated from other children. Per Licensee, there are no firearms or weapons stored in the home. There are no pets in the home. There are no bodies of water in the home. LPA did not observe any bodies of water.
Infant Care: Currently licensee is providing care to 2 infants over the age of 12 months. A play yard is available for napping. Napping cots are also available if children wish to use them. Licensee was advised Infants shall not be swaddled in care. Car seats shall not be used for sleeping. LPAs discussed the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.
Overnight Care: There is no overnight care provided at the moment. LPAs discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children's records were reviewed:
Staff records were reviewed: Licensee's pediatric CPR/First Aid was completed on 6/21/22. Staff did not have proof of required immunizations (measles, pertussis) per staff, they decline the flu vaccine-LPA advised to keep a written statement that they decline the flu vaccine. Per Licensee, she and the assistant completed the Mandated Reporter training in 2021 but did not receive a certificate. LPA advised to obtain the certificate to keep on file.
During inspection the children present were observed to be treated with dignity and respect, and free from corporal and/or unusual punishment.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 198009469
VISIT DATE: 10/21/2022
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Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm
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.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://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. To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to [email protected]. 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/process.

The deficiencies listed on the following page were observed by the LPAs and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D for Type B citations. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview conducted and report was reviewed with Licensee Ingrid King. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2022 01:39 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 10/21/2022 at 11:09 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 198009469

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in 2 out of 2 staff files reviewed. Licensee and Assistant did not have proof of required immunizations for measles and ertussis which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/21/2022
Plan of Correction
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Licensee will obtain proof of required immunizations for measles and pertussis (whooping cough) for herself and Assistant. Per Licensee and assistant, they decline the flu vaccine, LPA advised to keep a written statement regarding the declination. Licensee will send proof of immunization for measles and pertussis (whooping cough) for herself and assistant to LPA via email.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in 3 out of 5 children's records reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/21/2022
Plan of Correction
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Licensee will obtain proof immunizations for children enrolled and will provide proof to LPA via email.
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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/21/2022 01:39 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 10/21/2022 at 11:09 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE
FACILITY NUMBER: 198009469

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022

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 in 5 out of 5 records reviewed which did not contain the signed bottom portion of form LIC 995A-notification of parents rights which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/21/2022
Plan of Correction
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Licensee will provide LIC 995A to parents and will obtain the signed bottom portion of the form. Licensee will provide proof of signed bottom portion to LPA via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022


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