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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304204493
Report Date: 09/11/2019
Date Signed: 09/11/2019 04:14:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ALSOBROOK, MONICAFACILITY NUMBER:
304204493
ADMINISTRATOR:ALSOBROOK, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 804-5771
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:14CENSUS: 12DATE:
09/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Monica Alsobrook TIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Hawkins arrived at the facility for the purpose of conducting an annual inspection. LPA toured the facility inside and outside with Licensee Monica Alsobrook. The home was clean, orderly, and was at a comfortable temperature for the children present. Census was taken, and present during the inspection was the licensee and her assistant Leticia Lomeli with 12 children (ages five months to four years old; 4 infants, 8 preschoolers). The facility was within licensed capacity and the required ratio. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The home is a two story home with a backyard area that is fenced and used for child care. The second story is not used for day care and a gate is in place to prevent children from going up the stairs. The home has a fireplace that is screened to prevent children access. There are no accessible bodies of water on the premises. The home does have firearms, which are locked and kept separate from the ammunition. Anytime when firearms are present in a facility, they must be locked and inaccessible to children. The ammunition must be locked and separate from the firearms. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were properly stored and or locked away. LPA observed sharps/knives in the kitchen drawer with a safety latch that was broken. The smoke detector, fire extinguisher, and carbon monoxide detector were present and within regulations. The toys appear age appropriate and in good condition for the ages served. CPR & First Aid are current for licensee and assistant (exp. 4/2020). The home roster was reviewed and was found to be current, and posting requirements were met. Licensee did not have record of fire/disaster drill log available for review during today's inspection. LPA reminded licensee of requirements of disaster drills (documented every 6 months), posting requirements, children records, mandated child abuse and injury/death reporting. Children's records were reviewed for immunizations, identification of emergency information, and parents rights. Immunization records for Child #7, 9,12 were not available for review during today's inspection. Staff files were reviewed for immunization for pertussis, measles and influenza or waiver for influenza was verified. Licensee did not have certificate of completion of the mandated reporter training on file for review during todays inspection. ***continued on page 2 ***

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALSOBROOK, MONICA
FACILITY NUMBER: 304204493
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2019
Section Cited

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102417(g)(4) Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. This requirement was not met as evidenced by sharps/knives in the kitchen drawer with a safety latch that was broken. No children were present in the kitchen at this time.
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This posses a potential safety risk to children in care.
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Type B
09/27/2019
Section Cited

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102418(g) Immunizations.The licensee shall document each child's immunizations as required...and shall maintain such documentation for as long as the child is enrolled.This requirement was not met as evidenced by Child #7,9,12 not having immunizations record on file for review during todays inspection.
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 This poses a potential risk to the health and safety of the 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALSOBROOK, MONICA
FACILITY NUMBER: 304204493
VISIT DATE: 09/11/2019
NARRATIVE
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page 3

LPA reviewed Unusual Incident Reporting. Licensee was advised to contact Licensing Officer of the Day within 24 hours and complete the Unusual Incident Report (LIC 624B) within 7 days.

The following violations of the California Code of Regulations, Title 22; Division 12, Section 102417(g)(9)(A)(1); 102418(g); 102417(g)(4); Health & Safety Code 1596.8662(b)(1) were observed: see LIC 809D. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

An exit interview conducted where the report was discussed with the facility representative. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALSOBROOK, MONICA
FACILITY NUMBER: 304204493
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2019
Section Cited

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102417(g)(9)(A)(1) Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.
This requirement was not met as evidenced by no record of fire drill/disaster drill log during todays inspection. This poses a potential Health and Safety risk to the children in care.
Type B
09/27/2019
Section Cited

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1596.8662(b)(1) Mandated Reporter Training: On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided... This requirement was not met as
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evidenced by proof of completion of required mandated reporter training was not available for review during today's inspection for Licensee.This poses a potential safety risk to the children.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 5 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALSOBROOK, MONICA
FACILITY NUMBER: 304204493
VISIT DATE: 09/11/2019
NARRATIVE
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page 2
The home uses a land line telephone for child care. The licensee stated that she has a cell phone that is sometimes used for child care. The licensee was reminded that the cell phone must remain on the premises at all times during hours of operation. The licensee was reminded that must present at facility and ensure that children are properly cared for and supervised at all times. The licensee must make sure that a substitute adult cares for the children when licensee is temporarily absent. The licensee was also reminded that no child shall be left alone in a parked vehicle at any time.

The licensee stated she will not provide IMS. 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 inspection LPA Hawkins provided Licensee with an amended report and acquired signatures for repot dated 3/26/19.

A Child Care Provider’s Guide to Safe Sleep packet, and Safety Seat information were discussed and provided to the licensee. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf. The licensee was also informed that she can get Licensing Updates at www.ccld.ca.gov

The following were discussed: Individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to being present in the facility. Adults must contact a Live-Scan complete LIC 9163. If an adult is fingerprinted, cleared, and associated to another facility, the licensee must complete a Criminal Record Clearances or Exemption Transfer Request form (LIC 9182). Contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182 or LIC 9188) with copy of ID and Criminal Record Statement (LIC 508) to fax# (714)703-2831 prior to hiring adult. The licensee must immediately remove any individual from the facility and prevent from having contact with children in care when notified by the Department that said individual is not cleared to be at the facility.

continued on page 3

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5