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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018375
Report Date: 10/28/2021
Date Signed: 10/28/2021 11:42:40 AM

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:HOLCOMB FAMILY CHILD CAREFACILITY NUMBER:
198018375
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
10/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Lea HolcombTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA) Steven Rodriguez, conducted an unannounced Pre-Licensing inspection for an increase in capacity on this date. All Covid-19 precautionary measures were taken by both the LPA and the applicant during the visit. LPA had the temperature taken prior to admittance into the home. LPA Steven Rodriguez met with licensee Lea Holcomb who confirmed the family members residing in the home consists of 2 adults, herself and her daughter. The applicant is requesting a large facility of 14 children. She has had her small capacity licensee since 2007. Per licensee, operating hours will be Monday through Sunday 24 hours a day. Licensee states during Covid-19, parents are encouraged to drop off and pick up at the door while health checks are conducted such as temperatures being taken and a small health questionnaire

Licensee Ms. Holcomb guided analyst Rodriguez on a tour of the facility, indoors and out. All children under care were currently at school and there were no children in the home at the tie of the tour. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. The home was inspected for safety, comfort, cleanliness, telephone service (land line and cell phone available), heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Per licensee there are no weapons or firearms currently in the facility. Licensee also states there are no pets in the facility. The facility is a two story town-home with a small front patch of grass and no back yard. The home faces the street on Bradbourne ave. There is a walkway that immediately leads to the front entrance of the home. A table with hand sanitizer, masks, and a thermometer will be present to perform health checks of the children prior to entering the home. LPA observed a pool on the premises, however the pool is several hundred feet from the home and does not get used by the licensee or children in care. The pool gate is over five feet in height and is locked and requires a key to get in and out of the pool. LPA observed there are age appropriate toys and napping equipment (13 cots) and one crib for an infant in care under the age of two. Applicant rents property and a copy of the rental agreement was given as proof of renting.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Steven RodriguezTELEPHONE: (323) 430-3179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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 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: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375
VISIT DATE: 10/28/2021
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During the walk thru of the interior of the home LPA observed the smoke detector to be in the kitchen of the home, and an additional smoke/carbon detector in the living room. Licensee tested both and LPA was able to hear the alarm and found both to be operational. LPA also observed the required fire extinguisher (2A 10BC) located in the dining room with a service date of 02/04/2021

The areas observed by the LPA and confirmed by the applicant during the inspection, were the:



Off limits areas that include: three bedrooms upstairs, two bathrooms up stairs, the kitchen, and the upstairs outside balcony. The entire upstairs of the home is off-limits to the children but were still inspected by the LPA. There are kiddie gates the block off entraces to the kitchen and the upstairs. The applicant was advised that off-limit areas must be made inaccessible during operating hours. The applicant does understand that licensing staff may have access to off-limit areas during the inspection if necessary. There are safety knobs on the stove and secure latches on all kitchen cabinets.
The areas used by children include: Dining room, downstairs bathroom, and the main living room/play area.

The licensee states that she provides food for children in care. Analyst advised licensee, that if children bring food from home it should be properly labeled. Licensee has this in place already.

Infant Care: LPA advised the licensee to sleep infants where they can always be directly supervised and advised against sleeping infants in a separate room. LPA advised of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. A online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf.

Licensee is scheduled to take her preventative health course on November 4th. and will include the lead and nutrition training, pediatric first aid and cpr with expiration date 01/01/2022. Assistant has pediatric cpr/first-aid exp. 06/01/2023. Both the applicant and assistant completed their mandated reporter training on 05/27/2021. LPA observed there are first aid supplies available on the premises.

LPA discussed: Incidental Medical Services (IMS) policy. 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 and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Steven RodriguezTELEPHONE: (323) 430-3179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375
VISIT DATE: 10/28/2021
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At 11:30, the following was discussed with the licensee:

-Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.

· 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, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.

· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.

· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

· Fire and safety drills must be performed each month and documented for review by the Department.

· Smoking is prohibited in a family childcare homes.

· 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.

· No infant walkers, No Johnny jumpers, no saucer chairs, no trampolines and any other item that falls into that category are not permitted in the facility.

· Inspection Authority: All adults living and working in the home shall be made aware of the Department’s right to inspection of the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults, review documentation and observe off limit areas if needed.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Steven RodriguezTELEPHONE: (323) 430-3179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375
VISIT DATE: 10/28/2021
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The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.

- Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

· Liability Insurance was discussed; LPA advised licensee to review Title 22 Regulation 102417(m)(1) for additional information.

· Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

LPAs advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

At 11:15 pm LPA reviewed the LIC 311D - Forms/Records to Keep in Your Family Child Care Home.

LPAs consulted with applicant regarding COVID-19 health and safety guidelines on this date, applicant was provided forms to post via email. Licensing staff observed COVID- 19 postings posted in the day care on this date.

During this inspection LPA discussed PIN 20-06 CCP, Social and Physical Distancing Guidance and Healthy Practices for Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education. LPA reviewed with the applicant the Child Care Covid-19 Self-Assessment guide that the applicant filled out before this inspection.



The licensee signature on this report acknowledges that they have signed the licensee for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Steven RodriguezTELEPHONE: (323) 430-3179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
Page: 4 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: HOLCOMB FAMILY CHILD CARE
FACILITY NUMBER: 198018375
VISIT DATE: 10/28/2021
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********IF WE DON’T HAVE DOCUMENT

Licensee's email address was obtained during this inspection. The applicant was advised that email may be public information. (nynepercent@yahoo.com.com)

Based on licensing staff observations, the following corrections will be needed in order to receive a licensee for a large capacity.

1) Please complete the mandatory preventative health training including the lead and nutrition course .

Once this requirement has been met, the application will be submitted for final file review and licensure.

OR

This home currently meets the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of California Code of Regulations and the facility file will be submitted for approval for a small family childcare license. (Capacity 8)

At 11:30 am exit interview was concluded with Lea Holcomb, Licensee who acknowledges receipt of report. A copy of this report (LIC 809) and Appeal Rights (LIC 9058) were discussed, signed and printed and given to applicant on this date. Consultation regarding the licensing state laws and regulations, were conducted throughout this inspection.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Steven RodriguezTELEPHONE: (323) 430-3179
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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