191222148-8-28-2019-33-CC-AALN-BFGTXX-20190828150753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191222148
Report Date: 08/28/2019
Date Signed: 08/28/2019 03:07:57 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	GOODMAN FAMILY DAY CARE		FACILITY NUMBER:	191222148
ADMINISTRATOR:	GOODMAN, JACQUELINE TONI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 578-1815
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	12	CENSUS: 9	DATE:	08/28/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:53 PM
MET WITH:	Jacqueline Goodman		TIME COMPLETED:	03:25 PM

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Licensing Program Analyst, Ariel Cazares conducted an unannounced annual random site inspection to the home. Upon arrival, LPA met with Licensee Jacqueline and toured the facility. There were 9 children present and licensee's spouse. Spouse took 4 children for an outing. Individuals residing in the home are the licensee and spouse. Licensee’s operating hours are Monday-Friday 8am-5pm.

The home is a two story, 4-Bed, 4-Bath home. The following areas are used for day-care: Daycare activity room, nap area, kitchen, 1 restroom, frontyard and backyard. Off limit areas include: Second floor with 4 bedrooms and 3 bathrooms, the downstairs living room.

Licensee has the required postings in the kitchen. First Aid/CPR certificate are valid through 06/2021 for licensee and spouse. Licensee's disaster drill log notes last drill conducted on 05/2019. Licensee has a working telephone. Children's roster and files were reviewed and found to be complete and up to date. Mandated reporter training was conducted and completed on 1/8/19.

LPA observed a fire extinguisher in the kitchen that was purchased 2/4/19. There is an operational smoke detector and carbon monoxide in the kitchen that was tested by LPA. There are adequate age appropriate toys, books, and games. No hazards or violations were observed in the children's restroom. Cabinets and drawers were secured. There are no firearms present on the premises as stated by licensee. LPA inspected the backyard and frontyard and observed no hazards. There are no pools or spas, or other bodies of water. Currently there are no pets.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel Almazan	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GOODMAN FAMILY DAY CARE	FACILITY NUMBER: 191222148
	VISIT DATE: 08/28/2019

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The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.
· LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided.
· 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
· A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.
· LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov
· Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

No Deficiencies were cited on this visit.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee Jacqueline Goodman. A copy of this report and appeal rights were discussed and explained.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel Almazan	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

LIC809 (FAS) - (06/04)

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