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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021586
Report Date: 11/01/2024
Date Signed: 11/04/2024 02:25:07 PM

Document Has Been Signed on 11/04/2024 02:25 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: 14CENSUS: 0DATE:
11/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Dianne MiddletonTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 11/1/2024 at 9:15 am, Licensing Program Analyst (LPA) Carolyn Tuba conducted an announced pre-licensing inspection for the above address. LPA met with Licensee, Dianne Middleton. There were no children present during the visit. A Covid risk assessment was conducted. LPA had conducted a previous pre-licensing visit on 10/23/2024 due to corrections needed. LPA returned to observe that all corrections and changes were made from the initial pre-licensing visit.

The following corrections were necessary from the previous visit on 10/23/2024:
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

During today’s visit LPA observed and took photos of the swimming pool gate. A “Bodies of Water Checklist” was conducted on the prior visit of 10/23/2024 and checklist was adjusted for the swimming pool gate correction. LPA tested the gate, which is now self-closing and self-latching. LPA also observed that there is a lock on the gate for added security. LPA was informed there is a pool person who comes to clean the pool once a week, so LPA has asked the Licensee to install an alarm on the sliding glass door for added security measures, since the children will have access to the backyard and the swimming pool is in the back of the yard. LPA also suggested to the Licensee to check the pool gate each day before allowing children to play in the back yard and to ensure the gate is working properly.

LPA observed the first aid kit which includes surgical scissors, tweezers, and emergency manual.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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: 11/01/2024
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LPA observed Parent Board with all necessary documentation.

Licensee provided proof of TB test taken, however proof of MMR and Influenza is still required.

Licensee provided proof of online completed quiz for the orientation; however, she is still waiting to receive the certificate via email.

The following corrections are necessary from today’s visit.
Proof of the MMR and Influenza
Warning alarm for the sliding glass door leading out into the back yard.
Orientation Certificate

Based upon today’s inspection, there are some corrections pending at this time and licensee will be providing proof via email or text. The Family Child Care Home after those corrections made will meet Title 22 requirements. The application for relocation, will require a final review by the Department before issuing the license. Once licensed, the Licensee is required to adhere to the terms and limitations stated on the license.

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: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC809 (FAS) - (06/04)
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