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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014998
Report Date: 05/11/2022
Date Signed: 05/11/2022 11:31:26 AM

Document Has Been Signed on 05/11/2022 11:31 AM - 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 CAREFACILITY NUMBER:
198014998
ADMINISTRATOR:TATE, YULANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 764-1411
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Licensee Yulanda TateTIME COMPLETED:
11:40 AM
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An unannounced, in-person Case management-inspection was conducted on this date by Licensing Program Analysts (LPAs) Emiko Bell and Nolan Tcheng.

When LPAs arrived at 09:40 am, there was no one present at the residence. LPA Bell then phoned Licensee Yulanda Tate, who stated that she was at the store and would arrive shortly. Licensee arrived at 10:00 am and let LPAs into the residence. The reason for the inspection was announced.

As a precautionary measure against COVID-19, LPAs were face coverings the duration of the inspection and the COVID-19 screening questions were posed; Licensee responded no to all of the questions.

Census: There were no daycare children present.

Licensee's days and hours of operation are Monday-Friday, 06:00 am-06:00 pm. This is a single-story, single family residence with three bedrooms and one bathroom. LPAs only inspected the daycare room, as all other areas are off-limits to the daycare children.

The areas which have been designated off-limits were not inspected: the living room, the kitchen, and the three bedrooms.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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: 05/11/2022
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Physical Plant: The residence was inspected for safety, comfort, cleanliness, telephone service (licensee has a cell phone), heating and ventilation (there is a window air-conditioning unit in the daycare room as well as a door and a patio sliding door which can be opened for fresh air)
inaccessibility to poisons, detergents, cleaning compounds and the knives (there is a deadbolt) on the cabinet), medicine (none observed) and hazardous items that can pose a danger to children.

Toys and napping equipment: There are age-appropriate toys and napping equipment on the premises. Licensee has one crib and 3 mats. The children nap in both the daycare room and in the "sick room." In addition, licensee has several couches in the dining room that the daycare children can sleep on.

Parent Board: Licensee's Parent Board is posted in the daycare room. All required postings were observed.

Pets: Licensee does not have any pets.

Fire safety: Licensee has a fire extinguisher, size 2-A:10-B:C, which is mounted in the kichen on a wall. It was last serviced 04/22. Licensee keeps a fire drill log; the last fire drill was documented in February. There is a smoke detector mounted in the daycare room and a carbon monoxide detector hung on the wall above the kitchen doorway; both were tested and are operable.

Transportation: Licensee does not offer transportation.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
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: 05/11/2022
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Firearms: Licensee stated that there are currently no firearms or weapons on the premises.

Incidental Medical Services: 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

There is one First Aid Kit, which is kept in a kitchen cabinet.

Backyard: The backyard is completely surrounded by a brick wall The detached garage is locked by a padlock which is locked by key. There is no pool or other body of water on the premises.

Paperwork: Licensee has a Child Care Facility Roster. Licensee's Pediatric First Aid/CPR was issued by the American Red Cross and expires 07/22. Licensee's Mandated Reporter Training was taken 05/17/21 There are 8 children enrolled. Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months) The children's files were complete.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
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: TATE FAMILY CHILD CARE
FACILITY NUMBER: 198014998
VISIT DATE: 05/11/2022
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Based on the LPA's observations and records review, no deficiencies will be cited today 05/11/22.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Yulanda Tate.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC809 (FAS) - (06/04)
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