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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015371
Report Date: 04/22/2024
Date Signed: 04/22/2024 05:57:24 PM


Document Has Been Signed on 04/22/2024 05:57 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 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: 10DATE:
04/22/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kim BaileyTIME COMPLETED:
06:15 PM
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On 4/22/2024, at 2:30 pm, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced annual inspection visit for the above facility. Covid risk assessment was conducted. LPA met with Licensee, Kim Bailey. During today’s inspection LPA observed 10 children in care. A facility roster was available. Per Licensee, operating hours are from Monday – Friday 6:00 am – 6:00 pm and cares for children ages 8 weeks to 13 years of age. The licensee offers breakfast, AM/PM snack, and lunch to the children in care. Formula is provided by parents. Licensee provides all meals and is not part of a food program. The facility is currently operating as a large family childcare.

This is a one-story house which consists of a living room, dining area, kitchen, garage, front yard, back yard, side yard, playroom, 4 bedrooms and 2 bathrooms. Areas used by children were inspected as follows: Living room, dining area, playroom, kitchen, 1 bedroom, 1 bathroom, and fenced back yard. On rare occasion front yard is used for school-age children.

Areas off limits include: 3 bedrooms, 1-bathroom, side yard and garage.

The licensee states that 4 adults currently are living in the home and 1 minor child.

There is currently a above the ground spa that is behind a chain link fence and has no water except for some rainwater that has collected. There is a spa cover that does not have a lock. LPA advised that water should be drained, and a lock is required on the spa.

Licensee states that there are no firearms stored in the home. The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service. Fire and safety drills must be performed every 6 months and documented for review by the Department. Licensee conducted Emergency Drill February 2024, and
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2024
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: 04/22/2024
NARRATIVE
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documented. No one smokes at the family childcare home.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunization's (TDAP, MMR, TB and Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license. Assistant did not have proof of immunizations during the visit. Licensee will provide a copy for LPA’s records.

Detergents, cleaning compounds, medications, and other items, which could pose a danger, were determined to be inaccessible to children in care during this inspection. Medication is kept in off limit area bathroom and knives are kept in kitchen cabinets out of the reach of children. Cleaning supplies are kept out of reach of children.

LPA observed the required 2:A-10:B-C fire extinguisher and per Licensee it was last serviced in December 2023. State Fire Marshall standards, fire extinguisher shall be service annually. The smoke detector and carbon monoxide detector were tested and working properly. Currently facility has 2 dogs (Small Yorkie & Med Size Pit Bull Mix). The Yorkie is around the children, but the Pit Bull Mix is kept locked in the side yard away from the children.

Safe Sleep documentation and consultation was conducted on Infant Safe Sleep, 15-minute log, Infant Sleep Plan, and regulations for children under 24 months.

The licensee have completed training on preventive health practices including Pediatric First Aid and CPR, which includes the EMSA Sticker, and expires on 08/2025. Assistant will be taking the CPR/1st Aid course in the next few months. There are first aid supplies available. Licensee and Assistant have a current Mandated Reporting Training Certificate AB 1207 and expires 1/18/2026. LPA advised that Mandated Reporting needs to be renewed every two (2) years. The following link http://www.mandatedreporterca.com/ was provided.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be enclosed with a chain link fence and cement wall.


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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
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: 04/22/2024
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Children and Staff Records must be maintained and updated as needed and must be available for review by the Department. If Children and Staff leave the day care all records must be maintained for 3 years after leaving. LPA observed that children’s files had the following documents of the LIC 700, LIC 627 and LIC 995A available. There are currently no children on medication.


To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 [or facility representative] 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. LPA provided Safe Sleep documentation both in Spanish and English for both licensees.



Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: 04/22/2024
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Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensees was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Please see LIC809-D pages for deficiencies cited during today's visit in accordance with the California Code of Regulations Title 22, Division 12, Chapter 1

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Kim Bailey.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 04/22/2024 05:57 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 198015371

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(5)
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: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

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 due to above ground spa does not have currently have water, but some rain water has collected, there is currently a cover but the cover does not have a lock. The spa is currenly behind a chain link fence which poses/posed a potential health, safety or personal rights risk to persons in care.the spa cover
POC Due Date: 05/22/2024
Plan of Correction
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Licensee will order a spa cover and in the mean time will drain rain water that has collected and place a padlock on the chain link fence by 4/24/2023 and send a photo via email. Licensee will keep LPA posted for when cover spa cover arrives. LPA has given for the spa until 5/22/2024.l
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

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 due to assistant not having immunizations records available which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2024
Plan of Correction
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Licensee will provide immunizations by emailing to the LPA.
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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2024
LIC809 (FAS) - (06/04)
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