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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019364
Report Date: 02/15/2023
Date Signed: 02/15/2023 04:53:11 PM


Document Has Been Signed on 02/15/2023 04:53 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: 17DATE:
02/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Fallon GrahamTIME COMPLETED:
05:00 PM
NARRATIVE
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Case management inspection conducted by Licensing Program Analysts Jennifer Hua and Veronica Martinez-Garza. LPAs arrived at the front door of faciltiy at 1:07pm, LPAs rang door bell and knocked on door but no one opened the door. LPAs could hear children inside. LPA Veronica walked to the side yard to check. At around 1:10pm Licensee Fallon Graham pulled up on the driveway and allowed LPAs in the home. The purpose of the visit was announced. Upon entry, LPAs observed 9 children in the day care room (family room) alone with assistant Jiovondra Cullins, 5 of whom are infants and 12 were preschool-age. Licensee stated that she had car trouble and she went to run her car because the mechanic is going to check her car because her car is stalling and she transports kids. At around 1:16pm, Licensee toured LPA Hua the rest of the home, LPA observed an infant laying on bouncer chair in an off limits bedroom by himself. Licensee stated that she does not know why the baby is in the off limits bedroom. At around 1:23pm, Licensee took LPA to check the garage and her vehicle which is parked outside the garage on the driveway, at that point, LPA Hua and licensee observed 7 preschool children were outside by themselves in front of the side gate. Prior to taking LPA outside to check the car, licensee was stalling, folding kids' blankets and said she needs to get situated, at that point LPA Hua insist that licensee and LPA go outside and fold the blankets later.

Based on observations, deficiencies are cited on attached 809D.


Licensee was informed that a Non-Compliance conference will be scheduled. Licensee will be notified of the date and time of the conference. The conference will be conducted in the Monterey Park Regional Office.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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: 02/15/2023
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: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/15/2023 04:53 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: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2023
Section Cited

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Alterations to Existing Buildings or Grounds. Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Any changed from an area of the family child care home previously identified as
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Per licensee, will talk to assistant to not use areas the are off limits to children to ensure compliance
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"off limits" to an area where care and supervision will be provided to children in care.
The requirement is not met as evidenced by: LPA observed an infant was left alone laying on bouncer chair in an off limits bedroom. 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: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 02/15/2023 04:53 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: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2023
Section Cited

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Operation of a Family Child Care Home. The licensee shall be present in the home and shall ensure that children in care are supervised at all times. ie.... The requirement is not met as evidenced by.: LPA observed an infant was left alone in the off limits bedroom and 7 preschool age children were left unattend in front of the home by the side gate. s
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Per licensee, children were suppose to be playing in the fenced backyard and does not know why children were left outside if the front by themselves. Licensee will address issues with assistant and wlll hire 2 more assitants to ensure compliance
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 and a baby was left unattended in the off llimits bedroom. This poses an immediate risk to the health and safety of children in care.
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Type A
02/16/2023
Section Cited

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Personal Rights. Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: to receive safe, healthful
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Per licensee, will remove bouners chairs and put them in the garage that is off limits to children. will also talk to asisstant to not use bouncer chairs.
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To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. The requirement is not met as evidenced by: LPA observed 5 bouncer chairs on the premise. This poses an immediate tisk to 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: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4