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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400154
Report Date: 12/21/2022
Date Signed: 12/21/2022 03:25:21 PM

Document Has Been Signed on 12/21/2022 03:25 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KEITH & HOLLINS FAMILY CHILD CAREFACILITY NUMBER:
198400154
ADMINISTRATOR:BIONKA KEITH & BRANDON H.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 346-2080
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Licensee Brandon HollinsTIME COMPLETED:
03:35 PM
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Licensing Program Analysts (LPAs) Austin Estrada and Warren Birks conducted an unannounced required 1-year inspection at the above facility. LPAs met with the Licensee’s Brandon Hollins and Bionka Keith and informed the Licensee’s the purpose for the visit. LPAs provided the inspection Entrance Checklist (LIC 126). Licensee guided LPAs on a tour of the facility. There were no children present at the time of inspection. All adults present during the inspection have obtained a criminal record clearance or exemption. Individuals residing in the home have been discussed and noted. Licensee provides care to children ages 1 year to 10 years old and operation days/ hours are 7 days a week with various hours (less than 24 hours).

This is a one story 2 bedroom, 1 bathroom home which consist of a living room, kitchen, detached garage, front yard (fenced) and backyard (fenced). Off limits areas include One bedroom, kitchen, back yard, front yard, detached garage.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPAs reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. All documents were observed to be posted in living room.

Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster and Fire Drill log. Licensee did not have a Disaster and Fire Drill log at the time of inspection. Licensee was advised to conduct drills at least once every six months and to document all drills for verification.
There is an operable carbon monoxide detector and a smoke detector in the home. A fully charged Fire extinguisher (2A10BC) was observed and last serviced on 11/30/21. Licensee was advised to purchase or service the existing fire extinguisher yearly. The home maintains telephone service (mobile).
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KEITH & HOLLINS FAMILY CHILD CARE
FACILITY NUMBER: 198400154
VISIT DATE: 12/21/2022
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Per licensee there are no poisons stored in the home. LPAs advised Licensee that all poisons must be locked away, not only inaccessible. Isolation area for sick children waiting to be picked up is in the bedroom, away from the other children. Per Licensee there are no firearms or weapons stored in the home.
Food is provided by Licensee. LPAs advised Licensee if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

The home is observed to be clean and orderly. There are toys and other age-appropriate materials available for children. LPAs observed a wall heater in the living room made inaccessible to children in care. Children use the restroom in the hallway.

Per Licensee the outdoor play area is located on the front porch which was observed to be fenced. Per Licensee, children are supervised while playing outside. LPAs did not observe any pools, spas, or other bodies of water.

Per Licensee’s, transportation of children to and from school is available.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). All records were observed to be complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Licensees CPR/First Aid expires on 11/30/24. Licensees did not have their Mandated Reporter Training Certificate at the time of inspection.
Infant Care: Licensee does not care for any infants at the moment. LPAs observed one crib in the bedroom. LPAs reviewed Safe sleep regulations with Licensee, including LIC 9227 (Infant Sleep Plan) for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPAs 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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KEITH & HOLLINS FAMILY CHILD CARE
FACILITY NUMBER: 198400154
VISIT DATE: 12/21/2022
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 LPAs provided a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect).
Overnight Care: Per Licensee, overnight care is not provided at the moment. LPAs discussed the following: Licensee is aware that they must remain wake 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. 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.

LPAs advised Licensee that all adults age 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.

LPAs observed a hair stylist visiting to perform a service for the Licensee. LPAs advised Licensees to ensure that visitors who do not provide services shall have their fingerprint clearance and associated to the facility. LPAs also advised Licenses that all visitors performing a service shall be supervised at all times and never be left alone with children in care.

LPAs 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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/21/2022 03:25 PM - It Cannot Be Edited


Created By: Austin Estrada On 12/21/2022 at 02:45 PM
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: KEITH & HOLLINS FAMILY CHILD CARE
FACILITY NUMBER: 198400154

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by not having a serviced fire extinguisher within a year of last service date at the rime of inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/04/2023
Plan of Correction
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Licensee will provide proof of serviced fire extinguisher via email to LPA by POC due date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above by not having a updated Mandated Reporter Training Certificate at the time of inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/11/2023
Plan of Correction
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Licensee will provide proof of completed Mandated Reporter Training Certificate via email to LPA by POC due date.
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:Austin Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KEITH & HOLLINS FAMILY CHILD CARE
FACILITY NUMBER: 198400154
VISIT DATE: 12/21/2022
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Based on the LPA’s observations, interviews and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. Deficiencies include two type B violations. One Type B for not having a up to date Mandated Reporter Training Certificate and one type B violation not having a fire extinguisher serviced or purchased within the last year.

An exit interview was conducted and report was reviewed with Licensee, Brandon Hollins.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Appeal rights were discussed and provided to the Licensee.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
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