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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003995
Report Date: 02/11/2020
Date Signed: 02/11/2020 11:53:20 AM

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:BOOKER FAMILY CHILD CAREFACILITY NUMBER:
198003995
ADMINISTRATOR:BOOKER, RAYMONDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 399-5935
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:14CENSUS: 3DATE:
02/11/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Perez and Raymond BookerTIME COMPLETED:
12:00 PM
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Licensing Program Analyst, Bardo Baluyot and Licensing Program Manager, Ana Chico conducted an unannounced annual random site inspection to the home. Upon arrival, LPA met with Teachers, Maria Perez and Diana Knox. Ms. Perez provided a tour of the facility. Licensee Raymond Booker was not present upon arrival but arrived an hour later. LPA toured the child areas and observed 3 children in care. Individuals residing in the home are the licensee and his wife. Licensee’s operating hours are Monday-Friday 6am-6pm. Licensee also provides care after normal business hours. Currently there are 3 children enrolled.

This is a two story home. No stairs on the child care side. Areas used by children were inspected as follows: The Left side of the home which consist of 3 bedrooms, 2 bathrooms, living room with small kitchen and fenced back yard.



Per licensee, there are no weapons, firearms, swimming pool or spa on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premise. The smoke detectors, carbon monoxide and fire extinguisher (2A 10BC) are in operable condition. Lead teacher and assistant are current in Pediatric CPR/First Aid that will expire on 11/2020.

Areas off limits include: Right side of the home which consist of Kitchen, Living room, family room, bathroom, small office, bedroom, small den, upstairs has master bedroom with bath. Front yard.
**Rooms that are off-limits need to be made inaccessible during operating hours via doors and pressure gates** .
Disaster Plan, Emergency Disaster Drill conducted on 2/5/2020. Children's & staff records were reviewed. LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the children’s files that were reviewed during this inspection.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
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: BOOKER FAMILY CHILD CARE
FACILITY NUMBER: 198003995
VISIT DATE: 02/11/2020
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Licensee has the Parent’s Rights poster as well as all other posting requirements on wall in the living room. Licensee has a working telephone. Detergents and cleaning supplies were inaccessible to children. Fire extinguisher is current with a purchase date of 2/11/2020. The home has electrical outlet covers throughout and maintains a First Aid Kit. LPA inspected the backyard and found the garage locked. Currently there are no pets. Children's Roster is readily available and updated. Children’s Files were reviewe

No smoking, No infant walkers, Johnny jumpers, exersaucers, bouncers and any other item that falls into that category. LPA discussed earthquake /fire, disaster drills, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby, A Child Care Provider's Guide to Safe Sleep were provided to licensee. Licensee was also provided with the Department's brochure on the Effects of Lead Exposure and was advised to register with the CCLs department website for quarterly updates at Licensee and assistants have completed the Mandated Reporter Training. Licensee and assistant were advised that certificates expire every two years. Liability Insurance form in children files.


Facility does not administer any medications currently. 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) 514-0388 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
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: BOOKER FAMILY CHILD CARE
FACILITY NUMBER: 198003995
VISIT DATE: 02/11/2020
NARRATIVE
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It is recommended that a First Aid kit be available on premises. Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.

No deficiencies cited on this visit. Notice of Site Visit was provided and must be posted for 30 days. Failure to do so will result in a $100 civil penalty. Appeal rights provided and discussed. Exit interview conducted with licensee.



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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
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