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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015730
Report Date: 09/26/2019
Date Signed: 09/26/2019 05:22:00 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ROACHE FAMILY CHILD CAREFACILITY NUMBER:
198015730
ADMINISTRATOR:ROACHE, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 633-6144
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY:14CENSUS: 7DATE:
09/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Jennifer Roache, LicenseeTIME COMPLETED:
05:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Rita Ramos and Alicia Mooberry conducted an unannounced annual random inspection to the above facility. LPAs met with Jennifer Roache, Licensee, who guided analysts on a tour of the facility. Also present during this inspection, was Mary Roache, Licensee’s Assistant. Per Licensee, there are 7 children that are currently enrolled. Licensee has 2 children of their own in addition to the children enrolled. A current children’s roster was not available for review. There were 7 children present upon arrival. Facility operates Monday through Friday from 7:00AM to 6:00PM.

This is a 2-story home which consists of 2 bedrooms, 2 1/2 bathrooms, kitchen, dining room, daycare room, living room, 2 balconies. There is no front yard or backyard at this facility. Per Licensee, children use the daycare room downstairs. The children use the bathroom located next to the daycare room. LPAs observed that there is a fireplace in the living room, however, the living room is gated off and children do not have access to the living room. Per Licensee, areas off limits to children and parents include: the areas upstairs which include the 2 bedrooms, 1 1/2 bathrooms, dining room, living room, 2 balconies, and kitchen. The licensee provides food for children in care.

The licensee states that 1 adults and 2 children currently live in the home. Per Licensee, she currently has 2 assistants. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms stored in the home.

LPAs advised the Licensee to update their facility sketch to indicate which rooms are off-limits. LPAs inspected all areas Licensee identified that are accessible for children to use for safety, comfort, and cleanliness. There is telephone service via a landline. There is ventilation and heating (central). The following was observed and reviewed during this inspection.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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 6
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: ROACHE FAMILY CHILD CARE
FACILITY NUMBER: 198015730
VISIT DATE: 09/26/2019
NARRATIVE
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. Per Licensee, there are no poisons stored at the facility but understands that poisons are to be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/15/19, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. Where children less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. There are toys available for children. Appropriate sleeping arrangements were observed.

Currently, children are using the open driveway area for nature walks and for play time. The facility is located in a gated community area. LPAs obtained a declaration from the Licensee indicating that supervision including visual supervision is always provided and children are never left unattended.

The licensee is observed to be operating within the license capacity limitations.

The licensee has training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 04/2020. There are first aid supplies available.

Children’s records were reviewed, including emergency information and were observed to be complete.

The licensee does have proof of immunization against influenza, pertussis, and measles, however, the assistant does not.

LPAs observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file, however, the assistant does not.

LPAs issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection. -----------Page 2 of 4

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: ROACHE FAMILY CHILD CARE
FACILITY NUMBER: 198015730
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2019
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed
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child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training. This requirement is not met as evidenced by LPAs observing that the assistant does not have proof of the Mandated Reporter training certificate. This poses a potential health and safety risk to children in care.
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Type B
10/10/2019
Section Cited

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Employees or volunteers at day care center; immunization requirements; records; exemptions
Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
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This requirement is not met as evidenced by LPAs observing that the assistant does not have proof of Tdap immunization records. This poses a potential health and safety risk to 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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: ROACHE FAMILY CHILD CARE
FACILITY NUMBER: 198015730
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2019
Section Cited

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Operation of a Family Child Care Home
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by LPAs observing that there was no roster
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available for LPAs to review. This poses a potential health and safety risk to 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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: ROACHE FAMILY CHILD CARE
FACILITY NUMBER: 198015730
VISIT DATE: 09/26/2019
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LPAs advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

Capacity Handout (Small & Large) was provided during this inspection.

Based on the LPAs observations and records review, the following deficiencies listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Jennifer Roache, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: ROACHE FAMILY CHILD CARE
FACILITY NUMBER: 198015730
VISIT DATE: 09/26/2019
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All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 03/2019. LPAs advised the Licensee to conduct a drill by the end of the month.

There are no pets on the premises.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPAs did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. LPAs observed a trampoline in one of the balconies. Per Licensee, the trampoline belongs to their child and it is not in use by any of the children in care which is why it is in the balcony since that area is off limits to children in care. LPAs reminded the Licensee that trampolines and the items named above (or any items that fall in these categories) are not permitted in a licensed family child care home.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Licensee states that she is currently caring for infants. Licensee states that infants sleep in the daycare room where they are constantly supervised. LPAs provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPAs also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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. ----Page 3 of 4
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6