198004510-2-3-2023-33-CC-NTCG-CNPRZU-20230203122830

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004510
Report Date: 02/03/2023
Date Signed: 02/03/2023 12:28:41 PM

Document Has Been Signed on 02/03/2023 12:28 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:	JONES FAMILY CHILD CARE		FACILITY NUMBER:	198004510
ADMINISTRATOR:	JONES, WILLIAM & LISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 796-1386
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 0	DATE:	02/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	William (Bill) and Lisa Jones - Licensees		TIME COMPLETED:	12:55 PM

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	Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 11:15am LPA met with licensees, Bill and Lisa Jones. The licensee states that she currently has 9 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 12:30pm-5:30pm, Monday-Friday. Licensees care for School-Age children, 5-12 years old. This is a one-story duplex which consists of Converted garage, 3 bedrooms, 3 bathrooms (2 for children), kitchen, living room, play room 1, play room 2, front yard and backyard (fenced). The children use all areas of the property. Per licensee, areas off limits to children and parents include: the front housing unit. The licensee provides food for children in care. The licensee states that 2 adults and 0 children currently live in the home. All persons living in the home are noted on the attached LIC811. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises. PHYSICAL PLANT At 11:25am, LPA was lead on a tour of the facility by the licensee. Upon entry, the parent board was present on the wall, Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. The tour continued through the kitchen. The facility does provide snack to children in care and was observed. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children in a locked cabinet under the sink. At 11:30am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 03/15/2022, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Continuing to the living room, which is used as the main homework area and child care area. There are age appropriate games and toys present for the children in care. REPORT CONTINUES PAGE 1 of 3

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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: JONES FAMILY CHILD CARE	FACILITY NUMBER: 198004510
	VISIT DATE: 02/03/2023

NARRATIVE

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The tour continued down the hall. The child care bathroom was on the right and was observed to be clean and free of any hazards. Across from the bathroom is a play room with video games and toys available for the children in care to use. At the end of the hall is the additional play room, where there are additional games and movies for the children to enjoy. There is a table available for Pokemon play. The tour continued to the converted garage area, through the door by the kitchen. There are bikes, accompanied with helmets and safety gear, for the children to use. Per licensee, the children and licensee do bike rides around the neighborhood together. There were cubbies and tables for children to utilize. Licensees were reminded that converted garages should strictly be used for activity space and not for napping or eating. The Back yard was observed and has a large grass area for the children to play various activities. The front yard and driveway are also used as play space for children. The outdoor play area was observed to be fenced. This facility does not have nap time due to the length of time children attend. The licensee states that there is a land line on the premises. Per licensee, the play room at the end of the hall will be used as an area for an ill child until an authorized representative comes to pick up child. A mat is available for them. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. Smoke and carbon monoxide detectors were tested and are operable. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 04/2024 Licensees have complete mandated reporter training that expires on 01/16/2025. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

The following was discussed: -Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.

-There are no pets on the premises.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.
REPORT CONTINUES PAGE 2 of 3

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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: JONES FAMILY CHILD CARE	FACILITY NUMBER: 198004510
	VISIT DATE: 02/03/2023

NARRATIVE

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This facility does not care for infants. LPA advised licensees if that were to change, to contact the department for Infant Safe Sleep information.

Incidental Medical Services (IMS):

The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Licensees Bill and Lisa Jones, at 12:30pm. Copy of report provided.

END OF REPORT PAGE 3 of 3

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC809 (FAS) - (06/04)

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