198015371-12-18-2024-33-CC-CTUA-DC3W5Y-20241218155954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015371
Report Date: 12/18/2024
Date Signed: 12/18/2024 04:00:05 PM

Document Has Been Signed on 12/18/2024 04:00 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 CARE		FACILITY NUMBER:	198015371
ADMINISTRATOR/ DIRECTOR:	BAILEY, KIM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 369-6494
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	12/18/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:30 PM
MET WITH:	Kim Bailey		TIME VISIT/ INSPECTION COMPLETED:	04:00 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 12/17/2024 at 2:30 pm an unannounced Case Management – Deficiencies inspection was conducted by Licensing Program Analyst (LPA) Carolyn Tuba who was there to conduct a separate inspection visit and during the course of the investigation a separate deficiency was discovered on 11/7/2024. A Covid risk assessment was conducted. LPA met with Licensee, Kim Bailey. LPA took a census of 8 children with 2 adults.

LPA consulted with the Licensee that anytime a child sustains an injury at the family child care home and the child requires medical attention then it should be reported to the Department within 24 hours of the incident during our normal business hours. LPA consulted with the Licensee that medical attention could be urgent care, emergency room or by their physician or dental office. LPA also advised that if there is ever a question of any incident that is unusual, she can call the main number and ask for the On Duty Analyst of the day. Should the reporting be done by phone within the first 24 hours then an Unusual Incident Report (UIR) LIC 624B needs to be submitted within 7 days of the incident via email, (incidentreports@dss.ca.gov) fax or regular mail. LPA provided a copy of the UIR to the Licensee for her records.

LPA also discovered that during the investigation conducted on 11/7/2024 the report should have been marked as Needs Further Investigation, however it was marked as Unfounded. LPA has amended the report and corrected it. The Licensee was asked to sign, and a new copy was printed for their record.

The following deficiency listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiency that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and report was reviewed with the Licensee, Kim Bailey.

page 1 of 1

Ana Chico	TELEPHONE: (323) 981-3374
Carolyn Tuba	TELEPHONE: (323) 981-3350
	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

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 2

Document Has Been Signed on 12/18/2024 04:00 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: 12/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

102416.2 Reporting Requirements (3) Health and Safety Code Section 1597.467(b)(1) provides in part: "A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events: B) Any injury to any child that requires medical treatment.
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 12/18/2024
	Plan of Correction
1 2 3 4	LPA consulted with Licensee about reporting requirements and provided an Unusual Incident Report (UIR) LIC624B for her records.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 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.

Ana Chico	TELEPHONE: (323) 981-3374
Carolyn Tuba	TELEPHONE: (323) 981-3350
	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2