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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191511402
Report Date: 04/14/2022
Date Signed: 04/14/2022 07:06:44 PM


Document Has Been Signed on 04/14/2022 07:06 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 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: 7DATE:
04/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee Gail GrahamTIME COMPLETED:
07:30 PM
NARRATIVE
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An unannounced, in-person, Case management-deficiencies inspection was conducted on this date by Licensing Program Analyst (LPA) Emiko Bell in order to cite for deficiencies observed during today's inspection.

The first citation is being issued for the family child care home being out of ratio for 25 minutes.
iUpon arrival, LPA was greeted and let into the residence by Assistant Jordan Brown. There were seven children present in the TV room, the hallway and the playroom: two infants, four 3 year olds and one 5 year old. All children were napping with the exception of one of the 3 year olds.

As Assistant Brown was alone with more than six children and the 5 year-old child is enrolled in, and attending Pre-K, but there was not an additional adult attendant present OR a second child at least six years of age present, the family child care home was out of ratio until 02:55, when co-licensee Randall Graham arrived with an 11 year old child.

The second citation is being issued for an infant sleeping in a rocker instead of in a play yard or crib. (LPA took a photo of the infant in the rocker.)

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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRAHAM FAMILY DAY CARE
FACILITY NUMBER: 191511402
VISIT DATE: 04/14/2022
NARRATIVE
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LPA Bell informed Licensee Gail Graham that this report dated 04/14/22 documents two Type A citations which shall be posted for 30 consecutive days, as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Bell informed Licensee Gail Graham to provide a copy of this licensing report dated 04/14/22 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly-enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Licensee Gail Graham.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/14/2022 07:06 PM - It Cannot Be Edited

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: 04/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/15/2022
Section Cited

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STAFFING RATIO AND CAPACITY
A small family day care home may provide care for more than six and up to eight children, without an additional adult attendant, if all of the following conditions are met: (a) At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.
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-This requirement is not met as evidenced by: from 02:30-02:55, Assistant Jordan Brown was alone with two infants, four 3 year olds and one 5 year old. * This poses an immediate health, safety or personal rights risk to the children in care.*
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Type A
04/15/2022
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.
-This requirement is not met as evidenced by: upon LPA's arrival, LPA observed an infant sleeping in a rocker (photo was taken.)
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* This poses an immediate health, safety or personal rights risk to the 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3