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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021586
Report Date: 10/23/2024
Date Signed: 10/23/2024 12:48:34 PM

Document Has Been Signed on 10/23/2024 12:48 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:MIDDLETON FAMILY CHILD CAREFACILITY NUMBER:
198021586
ADMINISTRATOR/
DIRECTOR:		MIDDLETON, DIANNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 671-7003
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Dianne MiddletonTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 10/23/2024 at 09:20 am, Licensing Program Analyst (LPA) Carolyn Tuba conducted an announced relocation inspection for the above address. Licensee is relocating from prior facility # 198018367 which she is currently operating. LPA met with licensee, Dianne Middleton. There were no children present during the visit. A Covid risk assessment was conducted. Licensee guided LPA on a tour of the home. Individuals residing in the home are 1 adult and 2 children. Per licensee, hours of operation will be from 6:00AM to 5:00 AM Sunday to Saturday and will not exceed 24-hour care at any time. Licensee states that she will care for children birth to 17 years of age.

This is a single-family home which consists of 4 bedrooms, 2 bathrooms, living room, kitchen, front yard area, back yard, laundry room and garage. The children will use the living room, 1 bedroom and the bathroom located off the hallway, and the enclosed back yard. The bedroom will be used as isolation space for ill children. Areas off limits to children include the front yard area, 3 bedrooms, 1 bathroom, kitchen and garage. Doors will be kept locked, or baby gates will be in place to keep children out of the off-limit areas. The home was inspected for safety, comfort, cleanliness, telephone service, heating, and ventilation. LPA observed the inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Knives and other sharp utensils are in a high shelf in the kitchen cabinet. Cleaning products will be kept in a cabinet under the kitchen sink with a child proof latch. Electrical Outlets have child proof covers. Poisons and chemicals are kept in the garage which will be locked during operating hours.

During the visit licensee provided an updated facility sketch, Statement Acknowledging Requirement to Report Child Abuse (LIC9108), Current Children living in the home (LIC279B), copy of the Tdap immunization, copy of the CPR/1st Aid, EMSA approved, Health & Safety including Nutrition and Lead
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198021586
VISIT DATE: 10/23/2024
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Training Certificate, Pre-Licensing Readiness Guide (LIC9217), Emergency Disaster Plan for Family Child Care Home (LIC610A), (3) Criminal Background Clearances (LIC9182) for Licensee and 2 adults that are attached to current facility #198018367, Certificate of the Mandated Reporting Training, and Property Owner/Landlord Notification Family Childcare (LIC9151).

LPA provided licensee with prelicensing packet, safe sleep documentation, sample 15-minute sleep log, sample emergency drill, and Safe Sleep Infant Plan.

Per Licensee, she is part of a food program and will provide breakfast, lunch, AM/PM snacks, dinner. Parents will have to provide formula and baby food. If children bring food items from home, LPA advised that containers be labeled with child’s name and stored appropriately. LPA advised licensee to contact the Resource and Referral Program in her area and she stated she is currently in contact with them.

Licensee has completed the required health and safety training including nutrition and lead; mandated reporting training expires 10/23/2026 and the Pediatric First Aid and CPR which expires: 9/2026. Licensee has provided proof of Tdap, but requires proof of measles, mumps & rubella (MMR), TB and influenza (flu) or influenza (flu) waiver.

Applicant states there are 2 dogs (Goldendoodles) and they will be kept in the bedroom-(off-limit area) and separate from children in care.

There is an in-ground swimming pool and LPA conducted a Bodies of Water checklist. Currently the gate does not self-latch or self-close. Licensee has contacted the property management to repair. According to Licensee children will not be using the swimming pool.

LPA observed a back yard which is enclosed with a cement wall and chain link fence and there is currently a tree for shade. There is a cement slab and grass area for children to play. Swimming pool is located in the back area.

LPA did observe some age-appropriate toys and per licensee will be bringing more toys and materials once
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198021586
VISIT DATE: 10/23/2024
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she fully relocates. A fire extinguisher was observed (2A:10BC) and was last serviced February 5, 2024. First Aid kit was not available, per licensee she will have one available. Per Licensee, there no weapons or firearms in the home. There is no central heating and air in the home, but fans will be available. Smoke detector and carbon monoxide located in the hallway, living room and bedrooms were tested and observed to be operable. There is a fireplace in the living room and a baby gate is safely fastened to prevent children from having access. LPA took photo.

Per licensee children and infants will nap in the living room. (LPA observed a play yard). LPA provided safe sleep information 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 the 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. LPA reviewed with licensee that napping equipment should not block entrances or exits. Infant mattresses must be firm with tightly fitted sheets. Loose objects, bumpers, objects hanging, or objects attached to the cribs/play yards are not allowed. Each infant should have their own crib/play yard and bedding. LPA provided licensee of the regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and advised of the PIN 20-24-CCP.

LPA did not observe a Parent Board. LPA advised forms needed including PUB394 Notification of Parents Rights, LIC 610A Emergency Disaster Plan and LIC9148 Earthquake Preparedness and room for Facility License.

Licensee requires to correct the following:
Swimming pool gate needs to be repaired so that it self-latches and self-closes.
First Aid Kit including surgical scissors, tweezers and emergency manual.
Parent Board
Immunizations-Proof TB, MMR & Influenza
Proof of the Orientation Certificate
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198021586
VISIT DATE: 10/23/2024
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The following was discussed with the licensee:
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, immunizations, Mandated Reporter training certificate www.mandatedreporterca.gov, and a valid criminal record clearance associated to the facility license. 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. 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. Fire and safety drills must be performed every six months and documented for review by the Department.
Smoking is prohibited in a family childcare home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility.

Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

The facility license number must be on all advertisements, publications, social media or announcements with the intent to attract clients.

Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Childcare Home). The isolation area for a sick child waiting to be picked up will be in the on-limit area of the bedroom of the home.

Liability Insurance was discussed; LPA advised licensee to review Title 22 Regulation 102417(m)(1) for additional information. Licensee states she currently has liability insurance.

OTHER INFORMATION THAT WAS DISCUSSED:
Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices.
Per licensee, there are no dual licenses at this address.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198021586
VISIT DATE: 10/23/2024
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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. The applicant provided proof of control of property.

Because the licensee she rents/leases the home, proof of landlord notification was obtained. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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 reviewed with licensee the LIC 311D, Forms/Records to Keep in Your Family Childcare Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the licensee.

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 [applicant, licensee, or facility representative] 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.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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: MIDDLETON FAMILY CHILD CARE
FACILITY NUMBER: 198021586
VISIT DATE: 10/23/2024
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On this date, 09/24/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Licensee, Dianne Middleton.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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