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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191511402
Report Date: 02/08/2021
Date Signed: 02/09/2021 03:51:43 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:GRAHAM FAMILY DAY CAREFACILITY NUMBER:
191511402
ADMINISTRATOR:GRAHAM, GAILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 620-0737
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:14CENSUS: 1DATE:
02/08/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:09 PM
MET WITH:Licensee Gail GrahamTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Emiko Bell contacted the facility on 02/08/21 via telephone due to COVID-19 and precautionary measures in order to conduct an unannounced Case Management-deficiencies inspection. The purpose of the inspection is to cite for deficiencies found during an inspection. During the initial phone call, LPA spoke with Licensee Gail Graham, to whom the purpose of the call was stated; a tele-inspection was then conducted via FaceTime.

During today’s tele-inspection, licensee took LPA on a virtual tour of the playroom and the bedroom in which the children stay during daycare hours (referred to as the "TV room") in order to take census.

Census: There were staff and 1 child present during the inspection. Staff-child ratio was met.

Citations are being issued for the following deficiency observed on 12/22/20:

Upon LPA’s arrival to the residence at 2:00 pm, LPA was greeted and let into the residence by Assistant Jordan Brown. Once inside the residence, LPA inquired as to how many children were present; Asst. Brown responded. LPA then asked to be taken to the “TV room” and the playroom so LPA could see the children.

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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021
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: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402
VISIT DATE: 02/08/2021
NARRATIVE
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Once in the TV room, LPA observed C5 sleeping in a bouncer-type chair. When LPA asked for how long C5 had been sleeping in the chair, Asst. Brown stated, “Not long.” When asked to define how long "not long" is to her, Asst. Brown stated, “Between 30-10 minutes.” When asked why C5 was strapped into the chair, Asst. Brown replied that the child straps themselves in. Within a minute or so, LPA observed C5 whining and struggling to get out of the chair to reach a bottle which Asst. Brown was holding in her hand. LPA then asked Asst. to let C5 out of the chair, as it is not permitted for a child to be napping in a chair and because child should be let out of the chair once they are awake and are trying to be let out of the chair but are unable to do so since they are strapped in. Photos were taken of the child strapped in and struggling to reach the bottle in Asst. Brown’s hand. As the chair was in the TV room, LPA asked whether any other child slept in the chair, to which Asst. Brown replied no, stating that C5 is the only infant currently in care.

Two Type A citations are being issued because licensee has been issued a citation for this previously and because it violates Safe Sleep practices, which poses an immediate Health, Safety and/or Personal Rights risk to children in care.

Please refer to 809D for documentation of deficiencies.

Upon receipt, the Licensee shall post the Licensing report. This report shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty. A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402
VISIT DATE: 02/08/2021
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file immediately upon receipt from the parent. LPA provided Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

An exit interview has been conducted with Licensee Gail Graham. A copy of this report has been signed by LPA Bell. This report will be scanned via e-mail to Licensee Gail Graham, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. A hard copy of this report will be mailed to Licensee Gail Graham, who agrees to sign the bottom of each page of the 9099 and return the originals to LPA Bell in-person or via U.S. Mail.

A Notice of Site Visit was not provided to Licensee Graham since a physical inspection was not conducted.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/10/2021
Section Cited

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PERSONAL RIGHTS
Each child receiving services from a FCCH shall have certain rights that shall not be waived or abridged by the licensee... These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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-This requirement is not met as evidenced by: LPA observed C5 strapped in a bouncer-type rocking chair, napping. C5 had been napping in the chair from 10-30 minutes. A chair is not appropriate napping equipment. This poses an immediate Health, Safety and/or Personal Rights risk to children in care.
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Type A
02/10/2021
Section Cited

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INFANT SAFE SLEEP
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.
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This requirement is not met as evidenced by: LPA observed C5 strapped in a bouncer-type rocking chair, napping. C5 had been napping in the chair from 10-30 minutes. A chair is not appropriate napping equipment. This poses an immediate Health, Safety and/or Personal Rights risk to children in care.
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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 CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2021
LIC809 (FAS) - (06/04)
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