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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016029
Report Date: 03/10/2020
Date Signed: 03/10/2020 02:34:49 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:BAROMA FAMILY CHILD CAREFACILITY NUMBER:
198016029
ADMINISTRATOR:BAROMA, NONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 726-8268
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY:14CENSUS: 12DATE:
03/10/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Nona Baroma, LicenseeTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Thelma Razo and Anomeh Eivazian conducted an unannounced Required - 1 Year site inspection. Upon arrival, LPAs met with Licensee Nona Baroma and toured the facility. Licensee's two assistants were also present during the inspection. Per Licensee, three adults live in the home to include Licensee's husband and older son. There were 12 children present. Operating hours are from Monday through Friday, 8AM-6PM.

The facility is a two story home with 4 bedrooms, 3 bathrooms, kitchen, living room, dinning room and family room. According to licensee, three adults live in the home. Children use the living room, dinning room, one bathroom on the first floor, outdoor patio and back yard. Off limit areas include kitchen, 1 master bedroom on the first floor with private bathroom, second floor with 2 bedrooms and 1 bathroom, and garage.

Licensee has the Parent’s Rights poster, license and other appropriate forms posted. Licensee's First Aid/CPR certificate is valid. Licensee's disaster drill log notes last drill conducted on 2/14/20. Licensee has a working telephone.

Fire extinguisher has been serviced in the last year, card on extinguisher notes June 17, 2019. Smoke detectors and carbon monoxide detectors are operational. LPAs did not observe and exposed electrical outlets. The restroom is kept clean and orderly. No accessible hazards were observed. There is a First Aid Kit on top of the cubbies by the dining area. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. LPAs did not observe any pools or spas, or other bodies of water.


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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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: BAROMA FAMILY CHILD CARE
FACILITY NUMBER: 198016029
VISIT DATE: 03/10/2020
NARRATIVE
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The following were discussed: No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPAs discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.
LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, safe sleeping practices, lead poisoning, and staffing ratio based on capacity. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Handouts were provided to licensee. LPA advised the Licensee to access forms, regulations, and Provider Information Notices (PIN) on line at: www.ccld.ca.gov
  • Incidental Medical Services (IMS) policy was discussed. Licensee currently do not have children enrolled who required IMS. 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
  • Mandated reporter training must be renewed every two years. Licensee was reminded of the requirement to renew.

A deficiency was cited on today's inspection in accordance with Health and Safety Code. Refer to LIC809-D.

Exit interview conducted with Licensee Nona Baroma. A copy of this report and appeal rights were provided.
Page 2 of 2 - End of report
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: BAROMA FAMILY CHILD CARE
FACILITY NUMBER: 198016029
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/13/2020
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemptions
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
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care home.
This requirement was not met as evidenced by Licensee file review. The Licensee does not have immunization records on file. 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: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2020
LIC809 (FAS) - (06/04)
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