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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842040
Report Date: 07/17/2023
Date Signed: 07/17/2023 04:16:27 PM

Document Has Been Signed on 07/17/2023 04:16 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:BAILEY FAMILY CHILD CAREFACILITY NUMBER:
364842040
ADMINISTRATOR:KIM, BAILEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 392-6414
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kim BaileyTIME COMPLETED:
04:45 PM
NARRATIVE
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On date and time listed, Licensing Program Analyst (LPA) Aman Sharma arrived at the facility to conduct a required annual inspection. LPA toured the facility, both inside and outside. Records were reviewed, and the following was observed and/or discussed:
Normal days and hours of operation are: Monday- Friday 5:00am-7:00pm

OFF-LIMIT AREAS ARE LISTED AS FOLLOWS: Garage, entire upstairs, and backyard.

The facility is operating within the licensed capacity and appropriate ratios

· Appropriate supervision was being provided during this inspection

· A working telephone is present and current phone number is on file

· Appropriate fire extinguisher and smoke detector were in working order during today’s inspection.

· Carbon monoxide detector was missing and not in operation-SEE LIC809D

· The fireplace is screened off and blocked, making it inaccessible to children.

· Hazards and chemicals were observed in an on-limit area of the home- SEE LIC809D

· No weapons are currently present in the home. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Stairs were not properly barricaded, providing access to children in care-SEE LIC809D

· Verification of control of property is on file.

· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster and license are posted in a prominent location of the home.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 364842040
VISIT DATE: 07/17/2023
NARRATIVE
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·Appropriate Mandated Reporter Training for licensee was missing - SEE LIC809D

· Pediatric CPR and First Aid Card for licensee expires in 11/2024.

· No bodies of water on property at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Clean, safe and age appropriate toys were available to the daycare children.

· All furniture was not observed to be in safe condition- SEE LIC809D.

· Roster was not completed- SEE LIC809D

· Documentation of fire and disaster drills were on file – Last drill was conducted on: 02/2023

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Children’s records were found to be complete

· Licensee’s file was missing documentation-SEE LIC809D

· Resident and/or staff records reviewed indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage as an additional resource at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

-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.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
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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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 364842040
VISIT DATE: 07/17/2023
NARRATIVE
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-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

- 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.

- Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.



- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

The Licensee, Kim Bailey confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

A notice of site visit was given and must remain posted for 30 days. LPA Sharma informed licensee, Kim Bailey that this report dated 07/17/2023 documents Type A citations. Type A citation(s) shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Additionally, LPA Aman Sharma, informed the licensee, Kim Bailey to provide a copy of this licensing report dated 07/17/2023, that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted and this report was reviewed with the licensee, Kim Bailey.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 07/17/2023 04:16 PM - It Cannot Be Edited


Created By: Aman Sharma On 07/17/2023 at 03:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 364842040

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and licensee's own admission, the licensee did not comply with the section cited above. There was no carbon monoxide detector present in the home. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2023
Plan of Correction
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Licensee agrees to get a carbon monoxide detector installed no later than POC due date.
Type A
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA found 4 cracked and broken children's chairs in the dining room area where tables and chairs are kept. Additionally, LPA observed a big hole in the on-limits restroom door. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2023
Plan of Correction
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Licensee was able to put the cracked/broken chairs in an off-limit area of the home during today's inspection. Licensee agrees to board up the door until the maintenance team is able to come out to repair the door. Licensee agrees to submit proof of boarded off-door to licensing no later than POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 07/17/2023 04:16 PM - It Cannot Be Edited


Created By: Aman Sharma On 07/17/2023 at 03:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 364842040

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. There was no gate preventing access to the stairs or the second floor of the home. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2023
Plan of Correction
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Licensee agrees to purchase and submit proof of gate to barricade the stairs and prevent access to the second floor of the home.
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA found two smaller screwdrivers, used for prescription glasses, and two big screwdrivers in the living room area. LPA also found a box of pods labeled "washing machine cleaner" in one of the drawers a small side table in the living room. There was a bottle of "Old Spice" body wash on the stairs, accessible to daycare children. Additionally, LPA observed knives accessible on a counter to the left of the fridge in the kitchen area of the daycare. These are unsafe to keep accessible in a daycare, and poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2023
Plan of Correction
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During today's inspection, licensee was able to take the tools to an off-limit area of the home. Licensee agrees to submit proof of locked knives to licensing no later than POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 07/17/2023 04:16 PM - It Cannot Be Edited


Created By: Aman Sharma On 07/17/2023 at 03:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 364842040

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and licensees own admission, the licensee did not comply with the section cited above. The licensee was unaware that she needed to complete mandated reporter training's every two years. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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Licensee agrees to submit Mandated Reporter Certificates for both, "general" and "child care providers" no later than POC due date. The mandated reporter training's can be found at: mandatedreportertrainingca.com
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee was unable to provide proof of MMR (measles) and TDap (pertussis). This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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Licensee agrees to submit proof of MMR and TDap to licensing no later than POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 07/17/2023 04:16 PM - It Cannot Be Edited


Created By: Aman Sharma On 07/17/2023 at 03:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: BAILEY FAMILY CHILD CARE
FACILITY NUMBER: 364842040

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and licensees own admission, the licensee did not have a completed roster to present to LPA. Only children's names were listed, no other information was listed on the roster. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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Licensee agrees to submit copies of a completed roster to licensing, with all children enrolled and newly enrolled no later than the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023


LIC809 (FAS) - (06/04)
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