198015371-6-11-2021-33-CC-JGUN-C3VQ49-20210611114958

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015371
Report Date: 06/11/2021
Date Signed: 06/11/2021 11:50:07 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:	BAILEY FAMILY CHILD CARE		FACILITY NUMBER:	198015371
ADMINISTRATOR:	BAILEY, KIM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 369-6494
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	14	CENSUS: 6	DATE:	06/11/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Licensee, Kim Bailey		TIME COMPLETED:	12:00 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	On 06/11/2021 at 8:35 a.m., Licensing Program Analyst (LPA) Jose Guzman conducted an unannounced annual inspection. LPA met with Licensee, Kim Bailey, who guided this LPA on a tour of the facility. Also present during the inspection were Licensee's assistants, daughter, son in law, and husband. This is a single story home which consists of 4 bedrooms and 2 bathroom. There were 6 children present during today’s inspection. The children's roster was reviewed and is current. Disaster drill log was available during today’s inspection. Last drill conducted on 02/08/2021. Day Care days and hours are: Monday to Friday 6:00 AM- 5:00PM. Areas accessible to children were inspected as follows: Living room, kitchen, dining, day care room, bathroom, one bedroom, and front yard. Areas off limits include: Three bedrooms, one bathroom and back yard. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. Adults currently residing in the home have a have obtained a criminal record clearance. Licensee has pet dogs that are inaccessible to the children in care. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock. Per Licensee, there are no weapons or firearms on the premises. 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. The front yard is adequately fenced. There are rose bushes in the front yard with thorns that are accessible to the children in care. There are safe toys, play equipment and materials observed for children. Emergency Disaster was posted at the time of inspection. The facility has a 2A10BC fire extinguisher with the valve indicating fully charged and was purchased on 06/10/2021. Smoke and carbon monoxide detectors were tested and are in operable condition. The Licensee has a Pediatric First Aid and CPR, which expired on 06/08/2021 and the assistant has a current Pediatric First Aid and CPR, which will expire on 07/2022. Report continues- Page 1 of 3

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jose Guzman	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

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: BAILEY FAMILY CHILD CARE	FACILITY NUMBER: 198015371
	VISIT DATE: 06/11/2021

NARRATIVE

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Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping.

LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensee. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. Children’s records were reviewed to ensure that each child has an Identification and Emergency form.

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

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers Licensee completed training on .

The following was discussed:
· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided. Page 2 of 3

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jose Guzman	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

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: BAILEY FAMILY CHILD CARE	FACILITY NUMBER: 198015371
	VISIT DATE: 06/11/2021

NARRATIVE

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· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.
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Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jose Guzman	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

LIC809 (FAS) - (06/04)

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