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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019364
Report Date: 02/07/2023
Date Signed: 02/07/2023 01:47:56 PM


Document Has Been Signed on 02/07/2023 01:47 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:GRAHAM FAMILY CHILD CAREFACILITY NUMBER:
198019364
ADMINISTRATOR:FALLON TIANA GRAHAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 500-5600
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:14CENSUS: 8DATE:
02/07/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jiovondra Cullins & Fallon GrahamTIME COMPLETED:
02:00 PM
NARRATIVE
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Plan of correction inspected by Licensing Program Analyst Jennifer Hua. The purpose of this inspection is to follow up on the deficiencies cited on 1/31/2023. At 12:30pm LPA arrived and met with assistant Jiovondra Cullins. The purpose of the visit was announced. LPA observed assistant was alone with 8 children, 2 of whom are infants and 6 are preschool age. Per assistant, licensee just left facility. Licensee returned to the facility at 12:38pm. Per licensee, she had left to pick up a school-age child from school and dropped child off at parent's job site.

Based on above observation, deficiency is cited on attached 809D.

The following were observed to be corrected during this visit:

Babies were not napping in car seat
Assistant Jiovondra Cullins has renewed the mandated reported certificate on 2/3/2023 and her file is complete.with her T.B. test, and immunization - MMR and Tdap
LIC 9227 and 15 minute sleep log observed
Medical consent form in files.
Updated sketch observed and licensee stated she also mailed it
Roster has been updated.

During today's Plan of Correction Inspection, LPA addressed the incident reported on 3/11 and 3/16/21. LPA advised Licensee that she review her policy pertaining to ill children. Parents of guardians should ensure that children attending are in good health prior to drop off. LPA informed Licensee that health check are always recommended.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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: GRAHAM FAMILY CHILD CARE
FACILITY NUMBER: 198019364
VISIT DATE: 02/07/2023
NARRATIVE
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Upon receipt of this report documenting a substantiated complaint allegation and a Type A deficiency, the licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.

Exit interview was conducted with Fallon Graham, licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. .
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 02/07/2023 01:47 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: GRAHAM FAMILY CHILD CARE
FACILITY NUMBER: 198019364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/08/2023
Section Cited

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Staffing Ratio and Capacity. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). The requirement is not met as evidenced by: Upon arrival at 12:30pm, LPA observed assistant was alone with
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Licensee returned to facility at at 12:38pm,.
Per licensee, in the process of hiring another assistant to ensure compliance and will not leave facility unless ratio is met

Deificency corrected during visit.
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8 children 2 of whom are infants and 6 of whom are preschool-age. Licensee if over ratio by 2 children. This poses an immediate 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) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
LIC809 (FAS) - (06/04)
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