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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015371
Report Date: 05/06/2019
Date Signed: 05/20/2019 03:45:12 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:BAILEY FAMILY CHILD CAREFACILITY NUMBER:
198015371
ADMINISTRATOR:BAILEY, KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 369-6494
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:14CENSUS: 8DATE:
05/06/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kim Bailey, Licensee TIME COMPLETED:
01:00 PM
NARRATIVE
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An Annual/Required inspection was conducted Licensing Program Analyst (LPA) Carlos Gonzalez. LPA met with Kim Bailey, Licensee who guided Analyst on a tour of the facility. Also present was Licensee's Assistant, Brittanie Vigil. LPA observed a total of eight (8) children in care, including Licensee's minor granddaughter. Per Licensee, thirteen (13) children are currently enrolled. A facility roster was provided and is current.

This is a single story home which consists of 3 bedrooms, 1 bathroom, living room, kitchen, dining area, and rear family room (children's activity area). Children have access to the living room, kitchen, dining room area, rear family room, bathroom, and front bedroom. Off-limits to children in care are the two (2) additional bedrooms. LPA observed a children's safety gate, which was in place to prevent children from gaining access.

Currently residing in the home are Licensee, her spouse, Adult daughter, and minor granddaughter. The home was inspected for safety, comfort, cleanliness, and proper ventilation. There is a swimming pool on the premises (rear back yard), which is adequately fenced and in compliance with Calif. Code of Regulations, Title 22 requirements. The back yard is off-limits to children in care. There is a "chime" on the door, in the family room, which alerts Licensee and Staff, in the event the door is opened. The front yard is used for outdoor play.

There are no weapons/or firearms on the premises. One (1) small dog was observed on the premises. Licensee's First Aid/CPR expires on 06/2019, however does not reflect "Pediatric", only "Adult." Fire drill was last conducted on 09/2018. There was no service tag on both of the 2-A:10-B:C fire extinguisher's located within the home. The smoke and carbon monoxide detectors were tested and are operable.

Based on LPA's observations, the deficiencies listed are being cited in accordance with California Code of Regulations, Title 22 requirements.
Report continues on next page 1 of 2
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 198015371
VISIT DATE: 05/06/2019
NARRATIVE
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Notice of Site Visit must be posted for 30 days, failure to post, will result in a $100.00 civil penalty.

Exit interview conducted with Kim Bailey, Licensee, including, but not limited to provider rights, appeal procedures, and agencies consultative role.
Report ends page 2 of 2
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 198015371
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2019
Section Cited
CCR
102423(a)(2)
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Personal Rights - Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To receive safe,
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Per Licensee, a written response will be provided to LPA by the POC due date to address children left in high chairs, when not eating. Licensee to indicate what steps she will take, when children in high chairs are done eating.
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healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not being met as evidenced by: five (5) children were observed sitting in high chairs, watching television. This is a potential risk to the health and safety of children in care.
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Type B
06/06/2019
Section Cited
CCR
102416(c)
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Personnel Requirements - The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not being met as
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Per Licensee, she will obtain an updated First Aid/CPR card to reflect "Pediatric," by the POC due date.
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evidenced by: Licensee was not in possession of a "Pediatric" First Aid/CPR card. Licensee was only in possession of an "Adult" First Aid/CPR card. This is a potential risk to the health and safety of 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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019
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: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 198015371
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2019
Section Cited
CCR
102417(g)(9)(A)(1)
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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. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.

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Per Licensee, a fire/or disaster drill will be conducted by the POC due date. Licensee will submit proof to LPA.
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This requirement is not being met as evidenced by: LPA determined that Licensee has not conducted a fire/or disaster drill since 09/2018. This is a potential risk to the health and safety of children in care.
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Type B
05/20/2019
Section Cited
CCR
102417(g)(1)
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Operation of a Family Child Care Home - The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement is not being met as evidenced by: licensee did not provide proof that the required fire extinguisher
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Per Licensee, she will either have the current fire extinguisher serviced or purchase a new one. Licensee will submit proof to LPA by the POC due date.
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has been recently serviced. This is a potential risk to the health and safety of 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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4