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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191511402
Report Date: 02/15/2023
Date Signed: 02/15/2023 05:00:16 PM


Document Has Been Signed on 02/15/2023 05:00 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: 11DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Gail GrahamTIME COMPLETED:
05:10 PM
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On 2/15/2023 at 1:05 pm, Licensing Program Analysts (LPAs), Carolyn Tuba and Mary Silva conducted an annual inspection for the above facility. LPAs met with Jordon Brown and Randall Graham, who guided Analysts on a tour of the facility. Licensee was not available as she was picking up a school-age child from school. LPAs observed eight (8) children in care at the time of inspection. Licensee, Gail Graham arrived approximately at 1:50 pm. During the visit 2 school-age children and 1 preschooler arrived at the facility, bringing the total ratio to 11 children in care. Per Licensee, thirteen (13) children are currently enrolled at this time. A facility roster was available. Per Licensee, operating hours are from 5 AM to 9 PM Monday - Friday. The licensee provides food for children in care, breakfast, snacks, lunch, and dinner.

This is a single-story home consisting of three bedrooms, two bathrooms, kitchen, formal living room, dining area, office and enclosed family room used as a day care area. Children have access to the enclosed family room, bathroom in the hallway, and bedroom #1, #2 and #3 adjacent to the hallway. Bedroom # 1 is used as an isolation room for ill children. Per Licensee, the formal living room, dining area, kitchen, office (1/2 bathroom included), are off-limits to children in care. The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service (land line and cell phone).

Currently residing in the home are Licensee, and her spouse. Licensee was informed that all individuals must obtain a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. 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.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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: 02/15/2023
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Detergents, cleaning compounds, medications, and other items, which could pose a danger, were determined to be inaccessible to children in care during this inspection.

LPA observed the required 2:A-10:B-C fire extinguisher and the tag attached indicates that it was recently serviced on 2/2021 and expires 12/2025. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. The smoke detector and carbon monoxide detector were working properly. Per Licensee, there are no weapons, firearms, or bodies of water on the premises. Additionally, there are no pets on the premises.

LPAs observed children sleeping in bedroom #3 on mats. LPAs advised that infants under 24 months need to be constantly supervised. LPAs advised the Licensee with regards to safe sleep and that infants under 24 months shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name, date and initials of the person who checked on the child. Per Licensee they have not been documenting the 15-minute sleep log of the children under 24 months. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee.

The licensee is observed to be operating within the license capacity limitations. LPAs did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPAs did not observe any children sleeping in car seats.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee and her assistant’s Pediatric First Aid and CPR expire on 8/1/2024, which includes the EMSA sticker. There are first aid supplies available. Licensee, her assistant, and licensee’s spouse currently have the mandated reporting training certificate AB 1207, which expires on 7/12/2024.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 2 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: 02/15/2023
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Children’s records were reviewed, including emergency information and there were 4 children who had missing documentation.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be enclosed with a retaining wall. LPAs observed that the outdoor yard has toys and other materials for children to play with. LPAs did not observe any objects that can pose a danger to children in the outdoor yard.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.css.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee’s husband 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.

Based on LPAs observations and records review, the following deficiencies listed on the attached LIC 809 (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.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
Exit interview was conducted, appeal rights were given and a copy of this report was reviewed with the licensee, Gail Graham.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/15/2023 05:00 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: 02/15/2023

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 missing children's documentation from 4 children's files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/21/2023
Plan of Correction
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Per Licensee she will scan and email copy of documentation of each child to LPA.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

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 per Licensee does not currently have a 15 minute log for children under 24 months, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/16/2023
Plan of Correction
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Will begin documenting 15 minute sleep log for children under 24 months. Licensee will scan and email to LPA a copy of the form that you will be using.
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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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