198020227-11-21-2019-54-CC-JCHZ-BJ5QKC-20191121111407

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020227
Report Date: 11/21/2019
Date Signed: 11/21/2019 11:14:16 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	TOLIVER FAMILYCHILD CARE		FACILITY NUMBER:	198020227
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	11/21/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Erinn Toliver, Applicant		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	PRELICENSING INSPECTION CONDUCTED IN ENGLISH Licensing Program Analyst (LPA) Janeth Chavez conducted an announced pre-licensing inspection today. LPA met with Erinn Toliver whom guided LPA on a tour of the facility indoors and outdoors. Family members residing in the home are 2 adults and 1 child. Applicant has applied for a small family child care home license. Present during inspection is applicant, Gilbert Givens and licensee’s infant child. Per applicant operating hours will be Monday – Friday from 6:00am- 6:00pm. Applicant states she wants to care for children birth to 12 years old. There are no dual licenses at this facility as stated by applicant. Applicant was advised that children under the age of 10 years count in the capacity. All areas identified on the facility sketch were inspected. This is a two-story home which consists of 4 bedrooms, 2 full restrooms, kitchen, living room, dining room, attached garage, front yard (not fenced), & backyard (fenced) with pool. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The home has central air throughout the house. Areas off limits include: All upstairs (3 bedrooms and 1 full restroom), attached garage, applicant’s downstairs bedroom, backyard & pool. LPA observed a metal safety gate at the bottom of the stairs to prevent access to the upstairs. However, applicant does not have a safety gate at the top of the stairs. LPA observed a plastic safety door knob & a turn lock on the attached garage door to prevent access to children in care. As per applicant the backyard will not be used as a play yard for children due to the pool not having a fence around it. LPA observed a safety plastic door knob on her bedroom door. Applicant was advised to keep all off-limit areas inaccessible to day care children at all times. LPA observed a pool in the backyard that has a safety mesh pool cover and is attached to the ground with brass anchors. LPA observed direct access from the home to the pool area from a door in the attached garage, from applicant’s bedroom double sliding doors, and from the living room windows. Report continued on attached LIC 809C page 1 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

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 4

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: TOLIVER FAMILYCHILD CARE	FACILITY NUMBER: 198020227
	VISIT DATE: 11/21/2019

NARRATIVE

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LPA observed the sliding doors in applicant’s downstairs bedroom and a metal double door that can be opened to have access to the back yard. The door from the attached garage leads to the backyard where the pool is. Applicant stated she will place a gate on the side of the house to prevent access to the backyard. LPA observed that the pool does not have a fence that completely surrounds the pool. There is direct access from living room windows and doors to the pool area. The applicant must ensure that the cover is labeled F-1346-91 by the American Society for Testing Materials. The pool does not meet Title 22 Regulations currently.

Areas used by children include: Living room (main daycare area), kitchen, dining room, front yard (not fenced) and downstairs bathroom. These areas are accessible during day care hours. LPA inspected the bathroom that will be used by the children and is free of hazards. As per applicant the children will eat in the kitchen/dining room area. The living room will be the main daycare and napping area for children in care. LPA observed a fireplace in the living room area that needs to be barricaded to make it inaccessible. The fireplace is blocked by an L-shape sofa. Applicant stated that the front yard will be used as the play area. LPA observed the front yard not fenced and advised applicant to have 100% supervision when children are playing in the front yard. LPA did not observe any hazardous items in the front yard.

As per applicant the parents will drop off and pick up the children through the front entrance door. Applicant stated she will be providing transportation to and from school for children in care. LPA advised applicant that the vehicle shall have liability insurance and that the children shall have proper car seats when being transported. LPA observed the cleaning compounds and detergents are kept latched under the kitchen sink and in a cabinet near the restroom. Applicant stated that there are no poisons in the home. LPA did not observe any poisons in the home. There are no weapons or firearms in the facility. First Aid kit is available and is in the living room area. The home has electrical outlet covers throughout the home. LPA observed age appropriate toys and napping equipment in the home. LPA did not observe pets or firearms in the home.

The required fire extinguisher (2A10BC) is full and was serviced on (03/20/2019). There is an operable Smoke detector and Carbon Monoxide in the hallway area. Mrs. Toliver’s Pediatric CPR/1^st Aid certificate expires on 03/2021. The Preventative Health and Safety training was taken on 11/04/2018. Applicant has completed AB 1207 Mandated Reporter training on 11/14/2018. Applicants has met SB792 immunization requirements.

Forms to be posted:
LIC 610A Emergency Disaster Plan
PUB 394 Notification of Parents Rights Poster
Facility License

Report continued on attached LIC 809C page 2 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: TOLIVER FAMILYCHILD CARE	FACILITY NUMBER: 198020227
	VISIT DATE: 11/21/2019

NARRATIVE

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Facility Records: LIC 624B Unusual Incident/Injury Report, LIC 9040 Child Care Facility Roster, LIC9052 Employee Rights, LIC9108 Statement Acknowledging Requirement to Report Child Abuse.

Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9108).

Children’s records requirements: LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children In Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights.

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.

During this visit, the LPA Chavez reviewed and issued Forms/Records to Keep in Your Family Child Care Home (LIC 311D) to the applicant. LPA Chavez reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with licensee. *Infants should always sleep on their backs, mouths facing up, light bedding.

The following was discussed with the applicant:

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. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. All adults working or living in the home must have their criminal record clearances on file PRIOR to working or living in the home. If finger print cleared, their clearances must be associated to facility PRIOR to working or living in the home. Failure to comply will result in an immediate Civil Penalty being assessed.

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 adult/infant CPR & Pediatric First Aid certification, TB clearance, and a valid criminal record clearance associated to the facility license.

Report continued on attached LIC 809C page 3 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: TOLIVER FAMILYCHILD CARE	FACILITY NUMBER: 198020227
	VISIT DATE: 11/21/2019

NARRATIVE

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A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
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. Mandated reporter requirements were reviewed and explained
Fire and safety drills must be performed every six months and documented for review by the Department.
Smoking is prohibited in a family child care home, 24/7.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, No baby bouncers, 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.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority

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

The following corrections are due by December 15, 2019:

1.The home shall not have direct access to the pool area. There is direct access from the living room windows, downstairs bedroom, and from the attached garage. The pool does not meet Title 22 Regulations.

2. An extra gate at the top of the stairs is required.

3. The fireplace in the living room area needs to be barricaded.

Once the above corrections are cleared a final review of the application will be conducted by the Department. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

Exit interview was conducted with Erinn Toliver, applicant, who is in agreement with the above. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

End of Report 4 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4