191598788-2-5-2020-33-CC-JMOA-BLHVDQ-20200205152108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191598788
Report Date: 02/05/2020
Date Signed: 02/05/2020 03:21:23 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:	ABBEY FAMILY DAY CARE		FACILITY NUMBER:	191598788
ADMINISTRATOR:	ABBEY, CATHY WILLS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 799-1804
CITY:	SOUTH PASADENA	STATE: CA	ZIP CODE:	91030
CAPACITY:	12	CENSUS: 4	DATE:	02/05/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Cathy Abbey		TIME COMPLETED:	03:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst's (LPA) Judy Mora and Nolan Tcheng conducted an unannounced Annual/Random inspection. Licensing staff met with licensee, Cathy Abbey, who guided analyst on a tour of the facility. The licensee's son, Robert Abbey, was also present. There were 4 children present, 2 being infants. Family members residing in the home are 2 adults (criminal record clearances on file). There is a dog in the home that is usually kept in the backyard. This is a one story home which consists of 3 bedrooms, 1 bathroom, kitchen, living room (FIREPLACE: inaccessible), play room, garage and backyard (fenced). The children use the bathroom in the hallway, living room, play room, kitchen area, and backyard. Per licensee, areas off limits to children and parents include: 1 bedroom and detached garage. The licensing staff toured all areas used by children during this visit. Licensee states that there are currently 9 children enrolled, children's roster was reviewed and is current. Disaster drill log was not available, licensee has not conducted a drill in the last 6 months as required. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. There is a small set of stairs from the hallway leading to the play room. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in some areas of the home (see 809d). The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock. Per licensee, there are no weapons, firearms or bodies of water on the premises. There were safe toys, play equipment and materials observed for children. Emergency Disaster Plan was posted at the time of visit. Children’s records were reviewed to ensure that each child has an Identification and Emergency form, Consent for Emergency Medical Treatment and Immunization's are on file. *REPORT CONTINUES ON THE NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 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: ABBEY FAMILY DAY CARE	FACILITY NUMBER: 191598788
	VISIT DATE: 02/05/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Licensing staff observed that child #4 is missing their immunization record. The valve on the required 2A 10BC fire extinguisher indicates fully charged (serviced 07/06/2019). Smoke detector and carbon monoxide detector in the dining room were tested, and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire 04/2020.

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

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee. The Licensee does not currently have immunization documentation. This is a potential risk to the health and safety of children in care.

AB1207 Mandated Child Abuse Reporting – was reviewed and is due for renewal 04/2020. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed.

Safe Sleep Concepts were issued.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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: ABBEY FAMILY DAY CARE	FACILITY NUMBER: 191598788
	VISIT DATE: 02/05/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.

The licensee’s email address was obtained during this visit. The licensee was advised that email is public information.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

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.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

*END OF REPORT

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

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: ABBEY FAMILY DAY CARE	FACILITY NUMBER: 191598788
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/05/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/05/2020 Section Cited	1 2 3 4 5 6 7	Immunizations The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requiement was not met as evidenced by child fiel review. Child #4 does not have immunization's on file. This is a potential risk to the health and safety of children in care.
Type B 02/15/2020 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement was not met as evidenced by facility file review. The Licensee has not conducted an emergency disaster drill in the last 6 months as required. This is a potential risk to the health and safety of children in care.
Type B 03/05/2020 Section Cited	1 2 3 4 5 6 7	Employees or volunteers at family day care home; immunization requirements; records; exemptions The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is
	8 9 10 11 12 13 14	maintained by the family day care home. This requirement was not met as evidenced by Licensee file review. The Licensee does not have immunization records on file. This is a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14

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 Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4