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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019364
Report Date: 03/16/2023
Date Signed: 03/16/2023 12:30:19 PM


Document Has Been Signed on 03/16/2023 12:30 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: 13DATE:
03/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Gail GrahamTIME COMPLETED:
12:15 PM
NARRATIVE
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Plan of Correction inspection conducted by Licensing Program Analysts by Jennifer Hua.and Veronica Martinez-Garza. The purpose of the visit is to follow up on the deficiencies cited on 2/15/2023. Upon arrival, LPAs met with licensee's mother/assistant Gail Graham. LPAs were allowed entry and purpose of the inspection was announced. Upon entry, LPAs observed a 5 month old infant napping on sofa. Per assistant Gail Graham, licensee had just left the facility to go to the market about 10-15 minutes ago. LPAs toured the entire facility observed 13 children (3 infants and 10 preschools) in care supervised by licensee's mother. Per licensee's mother, there was an emergency with the other assistant. Licensee arrived at 11:22am. Per licensee, she left the facility about 40 minutes ago to take her other assistant to he Pomona Hospital. Per licensee and her mother, 3 of the children present are from the mother's day care. Licensee also stated another assistant is on their way.

Based on observation and information received, deficiencies are cited on attached 809D.

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: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
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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Document Has Been Signed on 03/16/2023 12:30 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: 03/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/17/2023
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:
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Per licensee, will make sure there are 2 assistants present and will continue to reduce enrollment to ensure compliance.
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Upon arrival at 11:00am, LPAs observed assistant was alone with 13 children, 3 of whom are infants and 10 are of preschool-age. This poses an immediate risk to the health & safety of children in care. This is 4th time citation is issued within a 2 month period
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Type A
03/17/2023
Section Cited

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Infant Safe Sleep. If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. The requirement is not met as evidenced by: Upon entry to facility, LPAs observed a 5 month old infant napping on the sofa.
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Per licensee, will ensure infant sleep in playpen and will remind staff.

Infant was placed to sleep in playpen during visit.
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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: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2