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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008295
Report Date: 08/23/2019
Date Signed: 08/23/2019 03:29:03 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GRAVES FAMILY CHILD CAREFACILITY NUMBER:
198008295
ADMINISTRATOR:GRAVES, TONNETTE'FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 480-2120
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:14CENSUS: 13DATE:
08/23/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Tonnette GravesTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced case management inspection. LPA met with Licensee Tonnette Graves who guided LPA on a tour of the facility. Also present were Licensees two assistants. There was a total of 13 children present during today's inspection.

During this inspection the following deficiencies were observed and are being cited in accordance with Title 22, California Code of Regulations:

LPA observed cleaning compounds to be accessible to the children in care in the bathroom used by the children.Licensee's assistant has fingerprint clearance for Department of Justice an F.B.I. only. Licensee submitted an LIC 9163B- Request for Live Scan Service- Long Term Care Ombudsman to Live Scan, which is the wrong form. The correct form is the LIC 9163. As a result, Assistant has not receive clearance for the Child Abuse Registry and is not associated to the facility. A civil penalty of $100.00 is being cited. LPA provided the Licensee with a copy of an LIC-9163.

Type A Only: Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.
Report continues on the next page
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GRAVES FAMILY CHILD CARE
FACILITY NUMBER: 198008295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2019
Section Cited

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Operation of a Family Child Care Home Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by the facility tour. LPA observed accessible spray cleaners in bathroom. This is an immediate
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risk to the health and safety of 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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GRAVES FAMILY CHILD CARE
FACILITY NUMBER: 198008295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2019
Section Cited

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Criminal Record Clearance- All individuals subject to a criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement was not met as evidenced by file review. Licensee's Assistant is fingerprint cleared for DOJ and FBI. Licensee submitted the incorrect form to Live
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Scan. As a result Assistant was not associated to the facility and has not been cleared for Child Abuse Registry. This is a potential risk to the health and safety of the children in care. A civil penalty of $100.00 was assessed during today's inspection.
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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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GRAVES FAMILY CHILD CARE
FACILITY NUMBER: 198008295
VISIT DATE: 08/23/2019
NARRATIVE
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The notice of site visit was posted where the parent/guardian of children enter and exit the facility. This notice shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with the Licensee, during which appeal rights were explained. A copy of the appeal rights (LIC9058 01/16) were provided.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4