198014998-8-24-2021-33-CC-LGOZ-C67R4Q-20210824124157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014998
Report Date: 08/24/2021
Date Signed: 08/24/2021 12:42:06 PM

Document Has Been Signed on 08/24/2021 12:42 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:	TATE FAMILY CHILD CARE		FACILITY NUMBER:	198014998
ADMINISTRATOR:	TATE, YULANDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 764-1411
CITY:	POMOA	STATE: CA	ZIP CODE:	91767
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/24/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Yulanda Tate		TIME COMPLETED:	12:58 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) Lissete Gonzalez conducted an unannounced annual inspection to the above facility on 08/24/2021. LPA arrived at the facility at 11:01AM and met with Yulanda Tate, Licensee who guided LPA on a tour of the facility. Per Licensee, there are 09 children currently enrolled attending staggered schedules. A current children’s roster was available for review. There were zero (0) children present upon arrival. This is a one story home which consists of 3 bedrooms, 1 bathroom, kitchen, dining room, living room, den, garage and backyard (fenced). The children use the bathroom in the hallway and den as noted in the facility sketch initially submitted. Per licensee, areas off limits to children and parents include: 3 bedrooms, detached garage. The licensee provides food for children in care. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. Individuals who reside in the home were noted and discussed. Per Licensee, they currently do not have an assistant due to low enrollment. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Licensee states that there are no firearms stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There a cellphone that is used; the cellphone remains at the facility during hours of operation. There is ventilation (air conditioning unit located in den). Safe toys play equipment and materials were observed. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and REPORT CONTINUES ON NEXT PAGE: 1 OF 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TATE FAMILY CHILD CARE	FACILITY NUMBER: 198014998
	VISIT DATE: 08/24/2021

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
26
27
28
29
30
31
32

understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary at the time of this visit.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 05/11/21, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

Licensee states that she is caring for one infant. Licensee states that infant sleep in the den where they are constantly supervised. Appropriate sleeping arrangements and a play yard was observed. The play yard did not hinder the entrance or exit from the sleeping space. LPA advised mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. The play yard was observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of PIN 20-24-CCP - Recently Approved Safe Sleep Regulations In Effect was provided to Licensee.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. The wood fence has a wood door that was observed to be self-latching. LPA did not observe any objects that can pose a danger to children on the outdoor yard at the time of this visit. Licensee advised, children must be supervised at all times during outdoor play.

The licensee is observed to be operating within the license capacity limitations at the time of this visit. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

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 07/2022. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children.

REPORT CONTINUES ON NEXT PAGE: 2 OF 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TATE FAMILY CHILD CARE	FACILITY NUMBER: 198014998
	VISIT DATE: 08/24/2021

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
26
27
28
29
30
31
32

Children’s records were reviewed, including emergency information and were observed to be complete. The licensee has proof of immunization against influenza, pertussis, and measles.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 08/13/21.

There are no pets on the premises. LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

Incidental Medical Services (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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Safe Sleep Awareness: PIN 19-02-CCP, COVID FAQ - PIN 20-11-CCP, Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD. COVID -19 Department of Public Health Guidance for Early Childhood
REPORT CONTINUES ON NEXT PAGE: 3 OF 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TATE FAMILY CHILD CARE	FACILITY NUMBER: 198014998
	VISIT DATE: 08/24/2021

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
26
27
28
29
30
31
32

Education was discussed with Licensee.

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

Exit interview was conducted with Yulanda Tate, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

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. Failure to maintain posting as required will result in a civil penalty of $100.00.

END OF REPORT PAGE: 4 OF 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4