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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014901
Report Date: 05/06/2022
Date Signed: 05/06/2022 04:09:58 PM


Document Has Been Signed on 05/06/2022 04:09 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:GRACIAN FAMILY CHILD CAREFACILITY NUMBER:
198014901
ADMINISTRATOR:GRACIAN, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 865-6546
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY:14CENSUS: 14DATE:
05/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Patricia Gracian, LicenseeTIME COMPLETED:
04:30 PM
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Inspection conducted in Spanish
Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. LPA arrived at 9:19am and was met by Yesica Andrade, Assistant (Staff1), who stated licensee is not present in the home. There were 13 children upon arrival, at 9:59am 1 more child arrived for a total of 14 children present, including 2 infants. Upon arrival LPA observed that the gate leading to the upstairs off limit areas was wide open (photo taken), this poses a potential risk to the health and safety of children in care. Also present was Maria Morales, Assistant (Staff 2) and Guillermo Andrade. Individuals residing in the home were discussed and noted. All adults reported to to be working with children or living in the home have obtained background clearance. Per licensee the hours of operation are Monday-Sunday 24 hours. Per licensee, there are no children receiving overnight or weekend care. Licensee arrived at 11:40am.

LPA explained the purpose of the inspection to Staff #1 and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access including the upper level of the home (off limits).

The facility is located in the rear of a two home property. The front home is licensed as Small Family Day Care #198400299. This is a two-story four (4) bedroom / two and a half (2 1/2) bathroom home.


Off limit areas: All 4 bedrooms and 2 bathrooms are on the second level of home.
Areas accessible to children are: the lower level which includes a living room, kitchen, dining room and attached garage (converted into for Day Care activity area), the 1/2 bathroom is located by the front door.

LPA observed a playpen in the converted garage. Licensee was advised not to sleep children in converted garage. Per licensee, the living area is utilized during napping time, appropriate napping mats and bedding were observed.


LPA observed the Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. -------Page 1 – Report Continues
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACIAN FAMILY CHILD CARE
FACILITY NUMBER: 198014901
VISIT DATE: 05/06/2022
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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced 7/2021, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via land line. LPA observed toys and other age appropriate material available for children in the daycare area and in the back yard. Isolation area for sick children waiting to be picked up is in living room, away from the other children.

LPA observed that detergents, cleaning compounds are in the kitchen inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home.

At 12:23pm LPA observed Child #1 to fall asleep in the high chair where child was eating. Staff took child #1 into the converted garage (daycare area). LPA then observed Child #1 sleeping on the floor on rug area where 4 toddlers were playing with blocks (Photos taken). This poses an immediate risk to the safety and personal rights of children in care.

Infant Care: LPA provided technical assistance to licensee and staff of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check and documentation for infants 0-24 months, and provided PIN 20-24-CCP. Licensee states infants sleep in the living room area where they are supervised by licensee or staff at all time.

Currently, children are using the side and back yard for outdoor play. The outdoor play area was observed to be fenced. LPA did not observe any objects that could be hazardous to children in care. There are no bodies of water in the back yard or around the home.

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, and documentation of 15-minute Infant Sleep Check (0-24 months)

Child #10 and #11 did not have files available, this poses a potential risk to the health and safety of children in care.

Facility found to be over the licence capacity based on record reviews, Child #1-#14 are all under age 6. There are no school age children present in care. This poses an immediate risk to the health and safety of children in care.

-------------------Page 2 – Report Continues

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GRACIAN FAMILY CHILD CARE
FACILITY NUMBER: 198014901
VISIT DATE: 05/06/2022
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Staff records were reviewed for approved Pediatric First Aid and CPR certification and current Mandated Reporter Training Certificate, and background clearance.

LPA advised licensee to check for the latest guidance, precautions and procedures for the local health department to avoid the spread of COVID-19 or other diseases.
LPA advised licensee on the following:
- Reporting Requirements

- Active supervision ensure children receive the care and supervision required at different ages, regularly assess if additional help is needed due to children's age and needs.

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



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.

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.

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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: GRACIAN FAMILY CHILD CARE
FACILITY NUMBER: 198014901
VISIT DATE: 05/06/2022
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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.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

When an A deficiency is cited: 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 LIC 9224 was also provided to the licensee.

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

Exit interview conducted in Spanish and report was reviewed with the Licensee, Patricia Gracian. Appeal rights were explained and a copy provided.



End of Report - Page 4
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 05/06/2022 04:09 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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: GRACIAN FAMILY CHILD CARE
FACILITY NUMBER: 198014901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on LPA observation, the licensee did not comply with the section cited above due to Staff placed Child #1 on the floor in garage after falling asleep in high chair, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
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LPA informed Staff of sleeping child and staff immediately placed child in playpen in the living room. Per licensee, they will review Safe Sleep regulations with staff and will obtain a written statement from staff stating they understand the safe sleep requirements, to be placed in staff file.
Type A
Section Cited
CCR
102416.5


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 Child 1-14 are age 5 and under. There are no school age children in care making the licensee over capacity limitations of the license which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
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Per licensee, they will disenroll 2 children and will provide a letter with parent signature to LPA via email by 5/9/22.

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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 05/06/2022 04:09 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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: GRACIAN FAMILY CHILD CARE
FACILITY NUMBER: 198014901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above the safety gate at the base of stairs leading to the offlimt area was wide open (photo taken) and only closed when LPA advised staff. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
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The gate was closed and the upstairs made inaccessible. Per licensee, they will ensure the gate remains closed and will provide training to staff to make sure they understand regulations including: inaccesiblitly to off limit areas.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview the licensee did not comply with the section cited above in 2 out of 2 infants in care under 24 months did not have the required safe sleep log which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2022
Plan of Correction
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Per licensee, they were not aware of the new Safe Sleep regulation requirement to check on infants every 15 minutes while they sleep and documentation. Per licensee, a sleep log will be created for Child #1 and Child #2 and a copy willbe sent to LPA via email by POC due date

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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 05/06/2022 04:09 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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: GRACIAN FAMILY CHILD CARE
FACILITY NUMBER: 198014901

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022

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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2
3
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Based on record review, the licensee did not comply with the section cited above in 2 out of 14 children's records were not available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/13/2022
Plan of Correction
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2
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Per licensee, they don't have facility files for Child #10 and #11 because they are new. Licensee will provide a completed facility file to Child Care Licensing staff via email by POC due date
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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2
3
4

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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7