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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018367
Report Date: 07/14/2022
Date Signed: 07/14/2022 11:44:13 AM


Document Has Been Signed on 07/14/2022 11:44 AM - 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:MIDDLETON FAMILY CHILD CAREFACILITY NUMBER:
198018367
ADMINISTRATOR:MIDDLETON, DIANNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 224-8604
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:14CENSUS: 2DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Dianne MiddletonTIME COMPLETED:
11:50 AM
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On 7/14/22 at 8:32AM, Licensing Program Analysts (LPA) Jennifer Hua & Veronica Martinez-Garza arrived to facility. LPAs rang door bell and knocked on door, no one answered. LPA Hua called licensee, and left message on licensee's voicemail and LPAs waited. Licensee called LPA back at 8:44am and said she is on her way back. Licensee arrived at facility at 9:06am. Licensee arrived with 3 children, ages 14, 11 and 8. Licensee stated that the 14 & 8 year old are her children. During the visit, licensee called her sister, who lives in the same apartment complex to take her 8 year old out. The sister arrived shortly. LPAs conducted an unannounced Required - 1 Year on-site inspection and was greeted by Licensee Dianne Middleton. A COVID-19 risk assessment was conducted. LPA stated the purpose of the visit and provided LIC 126 Entrance Checklist to facilitate the inspection. LPAs was guided to a tour by Licensee. This is a single-story home with living room, 4 bedrooms, 2 bathrooms, kitchen, dining area. There are 2 adults and 3 minors residing in the home. There is 1 day care child in care during the inspection. The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. Operation Hours are 7 days/week 23 hours/day.

All areas identified on the Facility Sketch were inspected to include the following:
· Childcare areas: Living room, dining area, kitchen, hall bathroom, There is no back or front yard. Licensee stated kids can play outside in front of the facility or the nearby apartment playground, licensee is physically outside with the children.
· Off limit areas: All bedrooms, bathroom in master bedroom

All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating (central). The licensees stated that there are no poisons in the home. The licensees understand that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198018367
VISIT DATE: 07/14/2022
NARRATIVE
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The valve on the required 2A 10BC fire extinguisher indicates it was fully charged and serviced on 6/27/22 as observed on service tag. Smoke and carbon monoxide combination detector in day care hallway were tested and were operable. Drills were conducted on 5/20/22. Per licensee, there are no bodies of water and no firearms and ammunition on the premises. Per Licensee, her 2 small dogs have been vaccinated. There were toys observed for children. Posting requirements were observed to be posted at the time of inspection.

Children records were reviewed and observed to be complete. Roster is being updated during visit.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

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 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. Per licensee, currently no infants enrolled.

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 Per licensee, no child on any medication at this time.



Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

All adults present have obtained a criminal record clearance. The licensee stated that she has current Pediatric First Aid/CPR certificate but unable to locate during visit. Licensee stated that she has completed required mandated reporter training but unable to locate certificate during visit.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198018367
VISIT DATE: 07/14/2022
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No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/tion-process.

LPA obtained an updated LIC279B during this inspection.

Deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days in an area accessible for review. Failure to post shall result in $100 civil penalty

Exit interview conducted licensee, and report was reviewed, copy of report given. Licensee was provided copy of the Appeal Rights..

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/14/2022 11:44 AM - 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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198018367

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in licensee unable to locate certificate during visit.which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2022
Plan of Correction
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Per licensee, will correct and submit copy of certificate by the POC due date
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 interview & record review, the licensee did not comply with the section cited above in licensee's vaccine record not available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2022
Plan of Correction
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Per licensee, will correct and submit copy to LPA by the POC due date

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: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 07/14/2022 11:44 AM - 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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198018367

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in licensee stated that she has current certificate but unable to locate certificate during visit. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2022
Plan of Correction
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Per licensee will correct and submit copy of certificate to LPA by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
LIC809 (FAS) - (06/04)
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