198013326-12-2-2021-33-CC-BBEL-C9BUY2-20211202145914

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013326
Report Date: 12/02/2021
Date Signed: 12/02/2021 03:00:04 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:	DAVIS FAMILY CHILD CARE		FACILITY NUMBER:	198013326
ADMINISTRATOR:	DAVIS, ELAINE & WENDELL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 805-0005
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	14	CENSUS: 2	DATE:	12/02/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee Elaine Davis		TIME COMPLETED:	03:00 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	An unannounced, in-person Annual/Required inspection was conducted on this date by Licensing Program Analysts (LPAs) Emiko Bell and Judy Mora. At 09:00 am, LPAs were greeted and let into the residence by licensee, to whom the reason for the inspection was announced. At 09:09 am, licensee began guiding LPAs on a tour of the residence.. Census: Staff-child ratio was met There were two adults and one minor in addition to the two daycare children present. Licensee's days and hours of operation are 24/7, though Licensee stated that she does not currently have children at night or during the weekends. This is a two-story, single family residence with four bedrooms and four bathrooms. All areas identified on the facility sketches were inspected in the following order: (indoors): the living room, the kitchen, the three bedrooms, the three bathrooms, and then (outdoors): the backyard. The areas which have been designated off-limits were not inspected: the living room, the kitchen, the family room, the converted garage, and upstairs.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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: DAVIS FAMILY CHILD CARE	FACILITY NUMBER: 198013326
	VISIT DATE: 12/02/2021

NARRATIVE

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Physical Plant: The residence was inspected for safety, comfort, cleanliness, telephone service (licensee has a cell phone and a landline), heating and ventilation (there is a ceiling fan in each bedroom and there is central heating and air-conditioning), inaccessibility to poisons, detergents, cleaning compounds (kept in a kitchen cabinet which has a childproof latch and in the garage,) medicine (none observed) and hazardous items that can pose a danger to children (e.g. the knives are also kept in the cabinet above the refrigerator).

Toys and napping equipment: There are age-appropriate toys and napping equipment on the premises. Licensee has one crib and 3 mats. The children nap in both the daycare room and in the "sick room." In addition, licensee has several couches in the dining room that the daycare children can sleep on.

Parent Board: Licensee does not have a Parent Board. Licensee stated she will post them on an art easel and place the easel outside, as the parents now enter through the side gate to drop their children off in the daycare room.

Pets: Licensee does not have any pets.

Fire safety: Licensee has a fire extinguisher, size 3-A:40-B:C, which is mounted in the pantry in the kitchen. It was last serviced 11/21. Licensee keeps a fire drill log. There is a smoke detector in the "sick room" and in the room where daycare is provided; both were tested and are operable. There are also two smoke detectors in the hallway between the downstairs bedrooms and the bathroom; as they are electrically wired, they were not tested. There is a carbon monoxide detector mounted in the kitchen; it was tested and is operable. There is a screen in front of the fireplace in the dining room.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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: DAVIS FAMILY CHILD CARE	FACILITY NUMBER: 198013326
	VISIT DATE: 12/02/2021

NARRATIVE

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Transportation: Though Licensee offers transportation, her vehicles were not inspected during today's visit. Per licensee, she has one booster and one regular car seat.

Firearms: Licensee stated that there are currently no firearms or weapons on the premises.

Incidental Medical Services: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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.

Backyard: The backyard is fenced on all three sides by a 6' tall brick wall; there is a grill in the backyard which has a cover on it.

Paperwork: Licensee has a Child Care Facility Roster. Licensee's Pediatric First Aid/CPR was issued by the American Heart Association and expires 10/22. Licensee's Mandated Reporter Training expired. Licensee provided verification of MMR, influenza and TDAP immunizations.
There are 10 children enrolled. Licensee has two assistants.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months)

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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: DAVIS FAMILY CHILD CARE	FACILITY NUMBER: 198013326
	VISIT DATE: 12/02/2021

NARRATIVE

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Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

Based on the LPA's observations and records review, no deficiencies will be cited today 12/02/21.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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: DAVIS FAMILY CHILD CARE	FACILITY NUMBER: 198013326
	VISIT DATE: 12/02/2021

NARRATIVE

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

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Elaine Davis

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

LIC809 (FAS) - (06/04)

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